FY 2020 Budget Page No. · mission. A reduction of $4.2 million in FY 2020 will reduce the number of recommendations the USPSTF will make from an average of 12 recommendations per

NIRSQ-1

DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

National Institute for Research on Safety and Quality (NIRSQ)

FY 2020 Budget Page No.

Organization Chart ..........................................................................................................................2

Appropriation Language .................................................................................................................3

Amounts Available for Obligation ..................................................................................................4

Budget Mechanism Table ................................................................................................................5

Major Changes in Budget Request ..................................................................................................6

Summary of Changes .......................................................................................................................8

Budget Authority by Activity ..........................................................................................................9

Authorizing Legislation ................................................................................................................10

Appropriations History .................................................................................................................11

Justification of Budget Request ....................................................................................................12

Budget Authority by Object Class .................................................................................................40

Salaries and Expenses ....................................................................................................................41

Detail of Full-Time Equivalent Employment (FTE) ....................................................................42

Detail of Positions .........................................................................................................................43

Programs Proposed for Elimination ...............................................................................................44

FTE Funded by P.L 111-148 ........................................................................................................46

Key Outputs and Outcomes Tables ...............................................................................................47

Summary of Proposed Changes in Performance Measures ...........................................................58

Physician’s Comparability Allowance Worksheet .......................................................................59

Significant Items ...........................................................................................................................60

NIRSQ-2

NIRSQ-3


NATIONAL INSTITUTE FOR RESEARCH ON SAFETY AND QUALITY

For carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security

Act, and section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act

of 2003, $255,960,000: Provided, That section 947(c) of the PHS Act shall not apply in fiscal

year 2020: Provided further, That in addition, amounts received from Freedom of Information

Act fees, reimbursable and interagency agreements, and the sale of data shall be credited to this

appropriation and shall remain available until expended.

NIRSQ-4



General Fund Discretionary Appropriation:

Appropriation (L/HHS, Ag, or, Interior)...................................... 334,000$ 338,000$ 255,960$

Across-the-board reductions (L/HHS, Ag, or Interior).............

Subtotal, Appropriation (L/HHS, Ag, or Interior)..................

Rescission........................................................................................

Reappropriation ..............................................................................

Proposed Supplemental Appropriation.......................................

Proposed Rescission......................................................................

Proposed Reappropriation.............................................................

Subtotal, adjusted appropriation..............................................

Secretary's transfer to ACF:.......................................................... (829)$ -$

Comparable transfer from:..............................................................

Subtotal, adjusted general fund discr. appropriation............ 333,171$ 338,000$ 255,960$

Trust Fund Discretionary Appropriation:

Appropriation Lines.......................................................................

Transfer Lines..................................................................................

Subtotal, adjusted trust fund discr. appropriation.................

Total, Discretionary Appropriation....................................

Mandatory Appropriation:

Appropriation Lines.......................................................................

Transfer Lines (non-add)............................................................... 98,626$ 112,527$ -$

Subtotal, adjusted mandatory. appropriation......................... 98,626$ 112,527$ -$

Offsetting collections from:

Unobligated balance, start of year...................................................

Unobligated balance, end of year.....................................................

Unobligated balance, lapsing............................................................ 234$ -$

Total obligations............................................................................. 332,937$ 338,000$ 255,960$

1/ For this and all other tables, the FY 2018 and FY 2019 columns contain information for the Agency for Healthcare

Research and Quality and are provided for convenience and transparency. The FY 2020 President’s Budget

consolidates AHRQ’s activities into NIH, and the FY 2020 column represents the request for the National Institute for

Research on Safety and Quality.

Amounts Available for Obligation 1/

(Dollars in Thousands)

FY 2018

Final FY 2019 Enacted

FY 2020

President's

Budget

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No. Dollars No. Dollars No. Dollars

RESEARCH GRANTS

Non-Competing

Patient Safety ..................................................... 50 21,612,239 62 24,073,445 85 33,573,000

Health Serv Res, Data & Diss......................... 155 41,989,837 155 40,951,722 144 39,860,282

Health Information Technology....................... 24 7,541,586 29 10,101,820 0 0

U.S. Preventive Services Task Force.............. 0 0 0 0 0 0

Medical Expenditure Panel Survey.................. 0 0 0 0 0 0

Total Non-Competing ....................................... 229 71,143,662 246 75,126,987 229 73,433,282

New & Competing

Patient Safety ..................................................... 36 13,765,994 37 14,043,816 18 7,000,000





Total New & Competing...................................... 151 36,843,838 124 35,212,996 32 10,131,718

RESEARCH GRANTS

Patient Safety ..................................................... 86 35,378,233 99 38,117,261 103 40,573,000





TOTAL, RESEARCH GRANTS........................... 380 107,987,500 370 110,339,983 261 83,565,000

CONTRACTS/IAAs

Patient Safety ..................................................... 34,068,767 34,158,739 24,703,000

Health Serv Res, Data & Diss......................... 36,174,733 38,561,278 14,950,000

Health Information Technology....................... 2,000,000 2,000,000 0

U.S. Preventive Services Task Force.............. 11,649,000 11,649,000 7,400,000

Medical Expenditure Panel Survey.................. 69,991,000 69,991,000 71,791,000

TOTAL CONTRACTS/IAAs 153,883,500 156,360,017 118,844,000

RESEARCH MANAGEMENT......................................…………………. 71,300,000 71,300,000 53,551,000

GRAND TOTAL

Patient Safety ..................................................... 69,447,000 72,276,000 65,276,000

Health Serv Res, Data & Diss......................... 94,284,000 96,284,000 57,942,000

Health Information Technology....................... 16,500,000 16,500,000 0

U.S. Preventive Services Task Force.............. 11,649,000 11,649,000 7,400,000

Medical Expenditure Panel Survey.................. 69,991,000 69,991,000 71,791,000

Research Management...................................... 71,300,000 71,300,000 53,551,000

GRAND TOTAL..................................................... 333,171,000 338,000,000 255,960,000

2/ Does not include mandatory funds from the PCORTF.

1/ For this and all other tables, the FY 2018 and FY 2019 columns contain information for the Agency for Healthcare Research and

Quality and are provided for convenience and transparency. The FY 2020 President’s Budget consolidates AHRQ’s activities into

NIH, and the FY 2020 column represents the request for the National Institute for Research on Safety and Quality.

Mechanism Summary Table by Portfolio 1/ 2/

FY 2018 FY 2019 FY 2020

Final Enacted President's Budget

NIRSQ-6



Major Changes in the Fiscal Year 2020 President’s Budget Request

The FY 2020 Budget proposes to consolidate the Agency for Healthcare Research and Quality’s

(AHRQ) highest priority activities in NIH in order to maximize efficiency of research. This

narrative compares NIRSQ funding levels to levels previously funded within AHRQ. However,

in addition to these quantifiable comparisons, additional efficiencies are anticipated as NIRSQ

works to coordinate health services and patient safety research across NIH and leverage other

NIH activities and resources.

Major changes by budget portfolio are briefly described below. NIRSQ’s FY 2020 President’s

Budget discretionary request totals $256.0 million in budget authority, a decrease of $82.0

million from AHRQ’s FY 2019 Enacted level. NIRSQ’s total program level at the FY 2020

President’s Budget is $256.0 million, a decrease of $194.6 million from AHRQ’s FY 2019

Enacted level. The total program level included $112.5 million in mandatory funds from the

Patient-Centered Outcomes Research Trust Fund (PCORTF) in FY 2019. AHRQ’s total

program level at the FY 2020 Request no longer includes mandatory funds from the PCORTF.

This mandatory funding stream ends in FY 2019.

Patient Safety (-$7.0 million; total $65.3 million): This research portfolio prevents, mitigates,

and decreases patient safety risks and hazards, and quality gaps associated with health care and

their harmful impact on patients. NIRSQ will provide $65.3 million for this research portfolio, a

decrease of $7.0 million from the prior year. Of this total, $32.5 million will support research

grants and contracts to advance the generation of new knowledge and promote the application of

proven methods for preventing Healthcare-Associated Infections (HAIs). Within this amount,

$12 million will be invested in support of the national Combating Antibiotic-Resistant Bacteria

enterprise.

Health Services Research, Data and Dissemination (HSR) (-$38.3 million; total $57.9 million):

HSR funds foundational health services research through research grant support to the

extramural community. NIRSQ will provide $39.9 million for non-competing research grant

support. A total of $3.1 million is provided for new investigator-initiated research grants. NIRSQ

proposes to request investigator-initiated applications targeting research focused on two of the

nation’s most pressing health care issues: Opioid Abuse (+$1.5 million) and Transforming to a

Value-based Delivery (+$1.5 million). Health Services Research Contracts total $15.0 million,

including $4.5 million to accelerate evidence on preventing and treating opioid abuse in primary

care, especially in older adults. In total, the FY 2020 President’s Budget provides $6.0 million in

funding to support the Secretary’s initiative to combat opioid abuse, misuse, and overdose.

Health Information Technology (-$16.5 million; total $0.0 million): The FY 2020 President’s

Budget ends dedicated funding for health information technology. Instead, health IT research

NIRSQ-7

will compete for related funding opportunities within patient safety and health services research

to ensure the highest priority research is funded.

U.S. Preventive Services Task Force (-$4.2 million; total $7.4 million): The U.S. Preventive

Services Task Force (USPSTF) is an independent, volunteer panel of nationally-recognized

experts in prevention and evidence-based medicine whose mission is to improve the health of all

Americans through evidence-based recommendations regarding the effectiveness of clinical

preventive services and health promotion to the general population. This program provides

ongoing scientific, administrative, and dissemination support to assist the USPSTF in meeting its

mission. A reduction of $4.2 million in FY 2020 will reduce the number of recommendations the

USPSTF will make from an average of 12 recommendations per year to 6 recommendations in

FY 2020.

Medical Expenditure Panel Survey (+$1.8 million; total $71.8 million): The Medical

Expenditure Panel Survey (MEPS), is the only national source for comprehensive annual data on

how Americans use and pay for medical care. The survey collects detailed information from

families on access, use, expenses, insurance coverage and quality. The funding requested

primarily supports data collection and analytical file production for the MEPS family of

interrelated surveys, which include a Household Component (HC), a Medical Provider

Component (MPC), and an Insurance Component (IC). A total of $70.0 million is required to

provide ongoing support to the MEPS, allowing the survey to meet the precision levels of survey

estimates, maximize survey response rates, and maintain the timeliness, quality and utility of

data products specified for the survey in prior years. In addition, an increase of $1.8 million is

provided to augment both the sample by 1,000 completed households (2,300 persons) and to

redistribute the sample across states. This will allow MEPS to improve its national estimates and

increase its capacity for making estimates of individual states and groups of states.

Research Management & Support (-$17.7 million; total $53.6 million): RMS activities provide

administrative, budgetary, logistical, and scientific support in the review, award, and monitoring

of research grants, training awards, and research and development contracts. As the organization

transitions to the NIH as an Institute, some programmatic activities will end. This reduction in

scope will require a decrease of 39 FTEs in FY 2020 from the FY 2019 Enacted level,

anticipated to be achieved through attrition, retirements, and a reduction in force if necessary.

Patient-Centered Outcomes Research Trust Fund (-$112.5 million; total $0.0 million): AHRQ’s

total program level at the FY 2020 President’s Budget no longer includes mandatory funds from

the PCORTF. This mandatory funding stream ends in FY 2019. The end of the PCORTF could

affect the Agency’s ability to ensure evidence from patient centered outcomes research is used

by health care systems and professionals to improve the quality, safety, and value of health care.

NIRSQ will use carryover resources until expended to disseminate and implement PCOR

research findings; obtain stakeholder feedback on the value of the information to be disseminated

and subsequent dissemination efforts; assist users of Health IT to incorporate PCOR research

findings into clinical practice; and provide training and career development for researchers and

institutions in methods to conduct comparative effectiveness research.

NIRSQ-8



Summary of Changes

AHRQ 2019 Enacted 1/

338,000$

NIRSQ 2020 President's Budget 1/

255,960$

(82,040)$

FY 2019 FY 2019 FY 2020 FY 2020

FY 2020 +/-

FY 2019

FY 2020 +/- FY

2019

Enacted FTE Enacted PB FTE PB BA FTE BA

Increases:

A. Built-in:

1. ...........................................................................................................

2. ...........................................................................................................

Subtotal, Built-in Increases.........................................................

A. Program:

1. Medical Expenditure Panel Survey.............................................. 69,991$ 71,791$ 1,800$

2. ...........................................................................................................

Subtotal, Program Increases....................................................... 69,991$ 71,791$ 1,800$

Total Increases...........................................................................

Decreases:

A. Built-in:

1. ...........................................................................................................

2. ...........................................................................................................

Subtotal, Built-in Decreases........................................................

A. Program:

1. Patient Safety.................................................................................. 72,276$ 65,276$ (7,000)$

2. Health Services Research, Data and Dissemination.................. 96,284$ 57,942$ (38,342)$

3. Health Information Technology................................................... 16,500$ -$ (16,500)$

4. U.S. Preventive Services Task Force........................................... 11,649$ 7,400$ (4,249)$

5. Research Management and Support (Program Support).......... 277 71,300$ 238 53,551$ -39 (17,749)$

Subtotal, Program Decreases...................................................... 277 268,009$ 238 184,169$ -39 (83,840)$

Total Decreases.......................................................................... 277 268,009$ 238 184,169$ -39 (83,840)$

Net Change.............................................................................. -39 (82,040)$

(Dollars in thousands)

1/ For this and all other tables, the FY 2018 and FY 2019 columns contain information for the Agency for Healthcare Research and Quality and are provided for

convenience and transparency. The FY 2020 President’s Budget consolidates AHRQ’s activities into NIH, and the FY 2020 column represents the request for the National

Institute for Research on Safety and Quality.

Total estimated budget authority........................................................................................................................................................................................................

(Obligations)...........................................................................................................................................................................................................................................

Total estimated budget authority........................................................................................................................................................................................................

(Obligations)...........................................................................................................................................................................................................................................

Net Change..........................................................................................................................................................................................................................................

NIRSQ-9



Budget Authority by Activity


Research on Health Costs, Quality and Outcomes $191,880 $196,709 $130,618

Medical Expenditure Panel Survey 69,991 69,991 71,791

Research Management and Support 71,300 71,300 53,551

Total, Budget Authority AHRQ 1/ 333,171 338,000

Total, Budget Authority NIRSQ 1/ 255,960

FTE 273 277 238

1/ For this and all other tables, the FY 2018 and FY 2019 columns contain information for the

Agency for Healthcare Research and Quality and are provided for convenience and transparency.

The FY 2020 President’s Budget consolidates AHRQ’s activities into NIH, and the FY 2020

column represents the request for the National Institute for Research on Safety and Quality.

FY 2018

Final

FY 2019

Enacted

FY 2020

President's

Budget

NIRSQ-10


NATIONAL INSTITUTE FOR RESEARCH ON SAFETY AND QUALITY 1/

Authorizing Legislation


FY 2019

Amount

Authorized

FY 2019

Amount

Appropriated

FY 2020

Amount

Authorized

FY 2020

President's

Budget

Research on Health Costs,

Quality, and Outcomes:

Secs. 301 & 926(a) PHSA......... SSAN 196,709$ SSAN 130,618$

Research on Health Costs,

Quality, and Outcomes:

Part A of Title XI of the

Social Security Act (SSA)

Section 1142(i) 4/ 5/

Budget Authority....................

Medicare Trust Funds 5/ 6/

Subtotal BA & MTF................

Expired 7/ Expired 7/

Medical Expenditure Panel

Surveys:

Sec. 947(c) PHSA......... SSAN 69,991$ SSAN 71,791$

Program Support:

Section 301 PHSA...................... Indefinite 71,300$ Indefinite 53,551$

Evaluation Funds:

Section 947 (c) PHSA ................... $0 $0

Total appropriations, AHRQ 3/ $338,000

Total appropriations, NIRSQ 2/, 3/ 255,960$

Total appropriation against

definite authorizations.........

SSAN = Such Sums As Necessary

1/ Section 487(d) (3) PHSA makes one percent of the funds appropriated to NIH for National

Research Service Awards available to AHRQ. Because these reimbursable funds are not

included in AHRQ's appropriation language, they have been excluded from this table.

2/ For this and all other tables, the FY 2018 and FY 2019 columns contain information for the Agency for

Healthcare Research and Quality and are provided for convenience and transparency.

The FY 2020 President’s Budget consolidates AHRQ’s activities into NIH, and the FY 2020 column represents

the request for the National Institute for Research on Safety and Quality.

3/ Excludes mandatory financing from the PCORTF.

4/ Pursuant to Section 1142 of the Social Security Act, FY 1997 funds for the medical treatment

effectiveness activity are to be appropriated against the total authorization level in the following

manner: 70% of the funds are to be appropriated from Medicare Trust Funds (MTF); 30% of the

funds are to be appropriated from general budget authority.

5/ No specific amounts are authorized for years following FY 1994.

6/ Funds appropriated against Title XI of the Social Security Act authorization are from the Federal

Hospital Insurance Trust Funds (60%) and the Federal Supplementary Medical Insurance

Trust Funds (40%).

7/ Expired September 30, 2005.

NIRSQ-11

Appropriations History Table

Budget

Estimate to

Congress

House

Allowance

Senate

Allowance Appropriation

AHRQ 2011

Budget Authority……………………………… -$ -$ -$ -$

PHS Evaluation Funds………………….. 610,912,000$ -$ 397,053,000$ 372,053,000$

Total……………….. 610,912,000$ -$ 397,053,000$ 372,053,000$

AHRQ 2012

Budget Authority……………………….. -$ -$ -$ -$

PHS Evaluation Funds………………….. 366,397,000$ 324,294,000$ 372,053,000$ 369,053,000$

Total……………….. 366,397,000$ 324,294,000$ 372,053,000$ 369,053,000$

AHRQ 2013



Total……………….. 334,357,000$ -$ 364,053,000$ 365,362,000$

AHRQ 2014



Total……………….. 333,697,000$ -$ 364,008,000$ 364,008,000$

AHRQ 2015

Budget Authority……………………….. -$ -$ 373,295,000$ 363,698,000$

PHS Evaluation Funds………………….. 334,099,000$ -$ -$ -$

Total……………….. 334,099,000$ -$ 373,295,000$ 363,698,000$

AHRQ 2016

Budget Authority……………………….. 275,810,000$ -$ 236,001,000$ 334,000,000$

PHS Evaluation Funds………………….. 87,888,000$ -$ -$

Total……………….. 363,698,000$ -$ 236,001,000$ 334,000,000$

AHRQ 2017

Budget Authority……………………….. 280,240,000$ 280,240,000$ 324,000,000$ 324,000,000$

PHS Evaluation Funds………………….. 83,458,000$ -$ -$ -$

Total……………….. 363,698,000$ 280,240,000$ 324,000,000$ 324,000,000$

AHRQ 2018


PHS Evaluation Funds………………….. -$ -$ -$

Total……………….. 272,000,000$ 300,000,000$ 324,000,000$ 334,000,000$

AHRQ 2019


PHS Evaluation Funds………………….. -$ -$ -$ -$

Total……………….. 255,960,000$ 334,000,000$ 334,000,000$ 338,000,000$

NIRSQ 2020

Budget Authority……………………….. 255,960,000$

PHS Evaluation Funds………………….. -$

Total……………….. 255,960,000$

2/ Excludes mandatory financing from the PCORTF.

Agency for Healthcare Research and Quality (2011-2019) 1/ 2/

National Institute for Research on Safety and Quality (2020) 1/ 2/


Quality and are provided for convenience and transparency. The FY 2020 President’s Budget consolidates AHRQ’s activities into NIH,

and the FY 2020 column represents the request for the National Institute for Research on Safety and Quality.

NIRSQ-12

Justification of Budget Request

National Institute for Research on Safety and Quality

Authorizing Legislation: Title III and Title IX and Section 947(c) of the Public Health Service

Act, as amended and Section 1013 of the Medicare Prescription Drug,

Improvement, and Modernization Act of 2003.

Budget Authority (BA)1:

FY 2020

FY 2018 FY 2019 FY 2020 +/- President’s

Final Enacted FY 2019 Budget

AHRQ Total2 $333,171,000 $338,000,000

NIRSQ Total2: $255,960,000 -$82,040,000

AHRQ FTEs2: 273 277

NIRSQ FTEs2: 238 -39

1For this and all other tables, the FY 2018 and FY 2019 columns contain information for the Agency for Healthcare Research and Quality and are provided for convenience and transparency. The FY 2020 President’s Budget consolidates AHRQ’s activities into NIH, and the FY 2020 column

represents the request for the National Institute for Research on Safety and Quality. 2Excludes mandatory financing and FTEs from the PCORTF. Includes reimbursable FTE.

Program funds are allocated as follows: Competitive Grants/Cooperative Agreements;

Contracts; Direct Federal/Intramural and Other.

Director’s Overview

The FY 2020 President’s Budget transitions the highest priority activities of the former Agency

for Healthcare Research and Quality to an Institute at the National Institutes of Health (NIH) –

the National Institute for Research on Safety and Quality (NIRSQ). Further integration in NIH is

anticipated in future years pending the results of a study whose findings will inform future

consolidation efforts. This proposed consolidation will allow for a more efficient, coordinated,

and seamless transfer of research efforts on the diagnosis, prevention, and cure of human

diseases developed by NIH to the frontlines of care. As a result of the ever-changing landscape

of the healthcare ecosystem, policymakers at the Federal, State, and local levels are grappling

with how to make qualitative and quantitative policy decisions in the absence of reliable,

integrated, accessible information. NIRSQ is uniquely positioned to leverage its core

competencies in health systems research, practice improvement, and data and analytics to

address these questions and improve quality, safety, and value of care. NIRSQ will better ensure

that NIH’s investments in medical science are translated into knowledge and practical tools that

can be adopted by physicians and other health care professionals to benefit patients and drive

toward value-based transformation.

NIRSQ-13

Fundamental Principle – Practice Improvement. Medical breakthroughs, increasing numbers

of people living with multiple chronic conditions, and the shifting landscape of the health care

delivery system all increase the challenges and complexities around providing safer care. Since

2000, with Congressional support, AHRQ has focused on assisting doctors and nurses in their

efforts to keep patients safe when they receive medical care. AHRQ has invested in research to

understand how health care systems can safely and reliably provide high-quality health care and

has translated the resulting findings into practical tools and training ready for real-world

implementation. We continue to develop new and innovative partnerships to ensure that more

health systems, doctors, nurses, patients, and communities are using them. The potential benefit

to American patients is extraordinarily high, as is the potential return on investment. AHRQ has

made progress in health care safety at the front lines of care, taking stock of the best science and

safe practices and giving providers the tools they need to implement changes to keep patients

safe. For example, AHRQ's longstanding Comprehensive Unit-based Safety Program has been

shown to substantially reduce healthcare-associated infections. Building on this successful

foundation, AHRQ programs have reduced the rates of infections in long-term care facilities,

improving safety for mechanically ventilated patients in intensive care units, and helping

ambulatory surgery centers make care safer for their patients. AHRQ recognized that multiple

perspectives are needed to develop solutions to complex challenges. Our Patient Safety Learning

Laboratories take a systems engineering approach to allow researchers and health care

professionals to identify and create practical solutions to patient safety problems. The learning

laboratories involve cross-disciplinary teams to address the patient safety-related

challenges providers face. As a result of these and other activities, AHRQ’s National Scorecard

on Rates of Hospital-Acquired Conditions shows that about 350,000 hospital-acquired conditions

were avoided and the rate was reduced by 8 percent from 2014 to 2016. National efforts to

reduce hospital-acquired conditions, such as adverse drug events and injuries from falls, helped

prevent an estimated 8,000 deaths and save $2.9 billion between 2014 and 2016, according to the

latest report.

Fundamental Competency – Health Systems Research: To improve health, the health care

delivery systems must put patients at the center of care. NIRSQ will continue to promote an

approach to health systems research called Person360 that asks researchers to place health care

delivery in context with both the individual patient’s social context and in relation to social and

human services. NIRSQ will continue to fund critical research on how the health care delivery

systems is organized and operates. We facilitate the analysis of current patterns of care in

current practice so that health outcomes can be improved. Health care delivery organizations are

rich with data, and those data are the fuel that transforms a health care delivery organization into

a learning health system. In a learning health system, internal clinical data are systematically

collected and analyzed, along with external data, to inform improvements in clinical practice.

We have demonstrated our continued commitment to health system improvement by awarding

$40 million in grants from Patient Centered Outcomes Research Trust Fund funding over 5 years

grants to 11 institutions that will represent a new, driving force to accelerate health system

performance and improvements in patient outcomes. These institutions also will establish

Learning Health System Centers of Excellence in Learning Health System Researcher Training

that will produce the next generation of LHS researchers to conduct patient-centered outcomes

research and implement the results to improve quality of care and patient outcomes. In FY 2020,

NIRSQ will continue funding for all continuing investigator-initiated health systems research,

NIRSQ-14

which creates a distributed portfolio in which researchers investigate a wide range of scientific

questions. History strongly suggests that letting scientists drive the research topics is the most

productive route to findings that will eventually translate into research that improves the quality

of health care. NIRSQ’s current delivery system research investments include the foundational

areas of health systems research (including safety, quality, and access) as well as emerging areas

and current topics (such as opioids, drug pricing, and value-based care). NIRSQ recognizes the

value of engaging operational leadership, including chief executive officers and other members

of the C-suite, in the development, conduct, and use of health systems research. NIRSQ will

continue to engage these organizational leaders to join clinical and research teams in efforts to

shrink the time between research advances and implementation to create better patient outcomes.

NIRSQ will continue to engage health care operation leaders in research to improve safety and

quality, and embed those results in how care is provided—all while continuing to engage patients

as partners in this critical process.

Fundamental Capability – Data: The healthcare system is undergoing transformation with a

drive toward value-based care. In alignment with the Secretary’s vision, achieving high value for

patients remains the overall goal of health care delivery, with value defined as treating patients as

consumers, treating providers as accountable patient navigators, paying for outcomes and

preventing disease before it occurs. The velocity, variety, and volume of data flowing into and

through the healthcare system is redefining how care will be delivered, what care patients will

receive, where the care is delivered, and how it is delivered. Transitions of care are the

movement of patients between providers or clinical settings and typically occur when primary

care providers refer patients to specialty care or when patients are discharged from the hospital to

subsequent care settings. Our grand challenge is developing data platforms to use this

information to improve patient safety, health care quality, and value. NIRSQ is in the

preeminent position to analyze this data with our two powerful data platforms—the Medical

Expenditure Panel Survey (MEPS) and the Healthcare Cost and Utilization Project (HCUP)

MEPS is the only national source of data measuring how Americans use and pay for medical

care, examining health insurance, and out-of-pocket spending. HCUP is the Nation’s most

comprehensive source of hospital data and also includes information on inpatient care, hospital-

based outpatient surgery, and emergency department visits.

MEPS data have been able to show insurance trends over time. Its 2017 Chartbook showed that

the percentage of employees working at establishments that offer health insurance ("the offer

rate") is very high when all private-sector employees are considered together (85 percent in

2017). However, the offer rate varies substantially by firm size. In 2017, the offer rate was 99

percent in firms with 100 or more employees and only 48 percent at small employers (those with

fewer than 50 employees). MEPS finds that that the offer rate was 94 percent for employees

working for large employers (50 or more employees) with primarily low-wage workers (where

50 percent or more of the employees made less than $12 an hour) but only 24 percent for low-

wage employers with fewer than 50 workers. MEPS data also showed estimates for average

annual premiums for employer-sponsored insurance in three coverage categories: single

coverage ($6,368), employee-plus-one coverage ($12,789), and family coverage ($18,687), and

found that, between 2016 and 2017, premium increases ranged from 4.4 percent to 5.5 percent—

higher than increases in recent years. MEPS data are used by the Bureau of Economic Analysis

in computing the U. S. Gross Domestic Product (GDP), by the Office of the Actuary in

https://meps.ahrq.gov/mepsweb/

https://meps.ahrq.gov/mepsweb/

https://www.hcup-us.ahrq.gov/

NIRSQ-15

calculating the National Health Expenditure Accounts, and by many states to assess time trends

in the provision of employer health benefits in their state. In addition, MEPS data are used

extensively to inform Congress on the impacts of changes in policy. For example, MEPS data

are used by the Congressional Budget Office to model the effects of policy proposals on health

care spending, and by the Medicaid and Chip Access and Payment Commission in determining

recommendations to Congress on periodic reauthorizations of the Children’s Health Insurance

Program (CHIP).

AHRQ’s data have also helped describe the impact of the opioid crisis. MEPS data show that in

2015 and 2016, nearly 4 million seniors, on average, filled four or more opioid prescriptions, and

nearly 10 million seniors filled at least one opioid prescription in those years. HCUP data

showed nearly 125,000 hospitalizations among older Americans involved opioid-related

diagnoses in 2015. HCUP data also show that opioid-related hospitalizations increased more than

50 percent and opioid-related emergency department visits more than doubled between 2010 and

2015. In 2015, 124,300 hospitalizations and 36,200 emergency department visits occurred due to

complications resulting from opioid use. HCUP data also show that seniors’ inpatient hospital

costs and emergency department charges were higher in 2015 if related to opioid use ($14,900)

rather than other conditions ($13,200) and that those admitted with an opioid-related problem

were also more likely to be discharged to another institution for post-acute care (37 percent) than

cases not involving opioids (30 percent). These data have been used to brief the Assistant

Secretary of Health on the use of opioids and rates of hospitalizations for opioid misuse among

the elderly, as well as the extent to which hospital-based births involve complications related to

the use of opioids and stimulants. AHRQ researchers also conducted analyses using MEPS for

the HHS Secretary’s initiative on drug pricing that examined trends in drug prices by payer and

drug patent status to help inform Departmental efforts to address the issue of rising prices.

HCUP’s Community-Level Statistics on Hospitalization Rates Related to Substance Use provide

substance use-related hospitalization rates in 2014 for opioids, alcohol, stimulants, and other

drugs and conditions drawn from more than 1,600 counties and two cities in 32 States to help

public health officials, clinicians, first responders, researchers and others help define and tackle

the most pressing local health challenges. While hospitalization rates in one county may suggest

that alcohol persists as the most urgent substance-related problem, rates in a neighboring county

may show an alarming rate in opioid-related hospitalizations. Having this data may assist local

health officials quantify the comparatively high burden of stimulant misuse on local hospitals.

Enhancing both the MEPS and HCUP platforms by greatly expanding the public data they use

gives Americans greater return on their investment in NIRSQ by adding to the types of data the

Agency make available; increasing the number of users; and by diversifying the ways in which

these data, tools, and research can be applied to make the best health care decisions possible. All

of these data efforts further NIRSQ's critical mission to improve safety, quality, and access to

care.

Vision for the Future: NIRSQ remains fully aligned with the DHHS value-based transformation

efforts. Recognizing the dynamic shifts that are occurring across the health care delivery

landscape and leveraging NIRSQ’s work, NIH is prepared to lead the Department in meeting the

enormous need for transformational strategies within health care organizations to move from

https://www.ahrq.gov/research/data/hcup/create-co-level-stats.html?utm_source=ahrq&utm_medium=en-2&utm_term=&utm_content=2&utm_campaign=ahrq_en3_6_2018

NIRSQ-16

“volume” to “value” in which the focus is on improving outcomes, reducing cost and expanding

choice for consumers. Moving forward, NIRSQ will focus its competencies of practice

improvement, health systems research, and data and analytics to address the most pressing issues

in healthcare using the latest technology available, including creating seamless care transitions

using interoperable digital health, creating a community-level data source for social determinants

of health, harnessing the power of predictive analytics to improve diagnosis, transforming care

for people living with multiple chronic conditions, and powering innovation in healthcare

through data to drive value-based transformation. NIRSQ will also share these strategies across

NIH and build upon existing work at NIH to increase the impact for the healthcare system.

NIRSQ-17

Authorizing Legislation: Title III and IX and Section 947(c) of the Public Health Service Act and

Section 1013 of the Medicare Prescription Drug, Improvement, and

Modernization Act (MMA) of 2003.

FY 2020 Authorization…………………………………………………………………....Expired.

Allocation Method....................Competitive Grant/Cooperative Agreement, Contracts, and Other.

Summary

NIRSQ’s program level for Research on Health Costs, Quality, and Outcomes (HCQO) at the

FY 2020 President’s Budget Level is $130.6 million, a decrease of $66.1 million from the FY

2019 Enacted level. A detailed table by research portfolio is provided below. Detailed narratives

by research portfolio begin on page 17.

FY 2018


FY 2020

President's Budget

FY 2020 +/-

FY 2019

BA 191,880,000$ 196,709,000$ 130,618,000$ (66,091,000)$

Research on Health Costs, Quality, and Outcomes (HCQO)

Division

AHRQ

FY 2018

Final 1/

AHRQ

FY 2019

Enacted 1/

NIRSQ

FY 2020

President's

Budget 1/

Research on Health Costs, Quality, and Outcomes

(HCQO):

Patient Safety 69.447$ 72.276$ 65.276$

Health Services Research, Data and Dissemination 94.284 96.284 57.942$

Health Information Technology 16.500 16.500 -$

U.S. Preventive Services Task Force 11.649 11.649 7.400$

Subtotal, HCQO 191.880 196.709 130.618

AHRQ/NIRSQ Budget Detail(Dollars in Millions)

1/ For this and all other tables, the FY 2018 and FY 2019 columns contain information about the Agency for

Healthcare Research and Quality (AHRQ) and are provide for convenience and transparency. The FY 2020

President's Budget consolidates AHRQ into the National Institutes of Healh (NIH), and the FY 2020 column

represents the request for the National Institute for Research on Safety and Quality.

NIRSQ-18

Authorizing Legislation: Title III and IX and Section 947(c) of the Public Health Service Act

FY 2020 Authorization………………….………………………………………………..………Expired.

Allocation Method………………......Competitive Grant/Cooperative Agreement, Contracts, and Other.

Patient Safety Research: The objectives of this program are to prevent, mitigate, and decrease

patient safety risks and hazards, and quality gaps associated with health care and their harmful

impact on patients. This mission is accomplished by funding health services research in the

following activities: Patient Safety Risks and Harms, Healthcare-Associated Infections (HAIs),

and Patient Safety Organizations (PSOs). A table showing the allocation by these activities is

provided below. Projects within the program seek to inform multiple stakeholders including

health care organizations, providers, policymakers, researchers, patients and others; disseminate

information and implement initiatives to enhance patient safety and quality; improve teamwork

and communication to improve organizational culture in support of patient safety; and maintain

vigilance through adverse event reporting and surveillance in order to identify trends and prevent

future patient harm.

Patient Safety Research Activities

(in millions of dollars)

FY 2018

Final

FY 2019

Enacted

FY 2020

Request

Patient Safety Risks and Harms

$28.581 $31.410 28.368

Patient Safety Organizations (PSOs) 4.866 4.866 4.395

Healthcare-Associated Infections

(HAIs) 36.000 36.000 32.513

Patient Safety Research Activities $69.447 $72.276 $65.276

FY 2018 Accomplishments by Research Activity:

Patient Safety Risks and Harms: The issue of diagnostic safety has not received the same level

of attention as other patient safety harms. In a study of patients seeking second opinions from the

Mayo Clinic, researchers found that only 12 percent were correctly diagnosed by their primary

care providers. More than 20 percent had been misdiagnosed, while 66 percent required some

changes to their initial diagnoses. By the end of FY 2018, AHRQ expects to fund $5.0 million in

new patient safety learning laboratories (PSLLs) along with $5.0 million in continuing PSLL

grants for a total investment of $10.0 million. These new PSLLs apply systems engineering

approaches to address both diagnostic and treatment errors in health care. AHRQ also continued

to support grants to combat the opioid epidemic. The early successful results of one grant

project will be spread among additional settings in a contract to be awarded by the end of FY

2018. According to the Joint Commission, an estimated 80 percent of serious medical errors

FY 2018


FY 2020

President's Budget

FY 2020 +/-

FY 2019

BA 69,447,000$ 72,276,000$ 65,276,000$ (7,000,000)$

HCQO: Patient Safety

http://onlinelibrary.wiley.com/doi/10.1111/jep.12747/full

https://www.aarp.org/health/conditions-treatments/info-06-2011/commonly-misdiagnosed-illnesses.html

NIRSQ-19

involve miscommunication between caregivers when responsibility for patients is transferred or

handed-off. Therefore in FY 2018, AHRQ continued accomplishments built on past successes

and focused on the continued expansion of projects that demonstrate impact in improving patient

safety, including ongoing support for the dissemination and implementation of successful

initiatives that seamlessly integrate the use of evidence-based resources in multiple settings such

as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) and

the Surveys on Patient Safety Culture. These projects address the challenges of healthcare

teamwork, communication and coordination among provider teams. Better teamwork and the

establishment of safety cultures in healthcare organizations are critically important to patient

safety. Both of these topics are widely recognized as foundational bases on which patient safety

can be improved.

Healthcare-Associated Infections (HAIs): In FY 2018, AHRQ released a new Toolkit to Promote

Safe Surgery. This toolkit, a product of the AHRQ Safety Program for Surgery, is designed to

help surgical units apply proven CUSP principles to improve safety culture and reduce surgical

site infections and other complications. Also in FY 2018, AHRQ made significant progress in the

three CUSP projects that are currently under way. 1) CUSP for antibiotic stewardship (official

title: AHRQ Safety Program for Improving Antibiotic Use) completed a pilot cohort in March

2018 in three integrated delivery systems that comprise all three care settings addressed by the

project: acute care hospitals, long-term care facilities, and ambulatory care settings. An acute

care cohort is currently ongoing in over 400 hospitals, including 6 Department of Defense and 79

critical access hospitals. Recruitment has begun for a long-term care cohort scheduled to begin in

250-500 facilities in FY 2019. 2) As of July 2018, CUSP for intensive care units (ICUs) with

persistently elevated rates of CLABSI and CAUTI (official title: AHRQ Safety Program for

Intensive Care Units: Preventing CLABSI and CAUTI) has recruited 425 ICUs in three cohorts

from six regions of the country to actively participate in the project. An additional 115 units have

been recruited to participate in a fourth cohort beginning in August 2018. 3) As of July 2018,

CUSP for improving surgical care and recovery (official title: AHRQ Safety Program for

Improving Surgical Care and Recovery) has recruited 277 hospitals in 44 States to participate in

the project. The hospitals range from those with fewer than 100 beds to those with more than 500

beds. The first cohort addresses colorectal surgery, and the second cohort also includes a focus

on orthopedic surgery.

Patient Safety Organizations (PSOs): Within the protected environment that affords privilege

and confidentiality safeguards, PSOs have used AHRQ tools to expand their implemented

quality and safety improvement programs to in nearly every State in the Nation. For example,

The Society for Vascular Surgery PSO utilized surgical data to reduce hospital stays and surgical

site infections and improve survival among patients on antiplatelet and statin medicines. By

aggregating and analyzing data from the vascular surgeons in their registries across the country,

the SVS PSO found that elective carotid endarterectomy (CEA) and endovascular aneurysm

repair (EVAR) were associated with significantly decreased post-operative length of stay (LOS)

from 2011 to 2017. Mean post-operative LOS for elective EVAR for all SVS centers plunged

from 2.75 days in 2010 to 1.8 days in 2017. Mean post-operative LOS for elective CEA for all

SVS centers plunged from 2.12 days in 2011 to 1.75 days in 2017. Also, use of chlorhexidine to

prepare the skin of surgical site incisions significantly reduced post-operative surgical site

https://www.ahrq.gov/professionals/quality-patient-safety/hais/tools/surgery/index.html

https://www.ahrq.gov/professionals/quality-patient-safety/hais/tools/surgery/index.html

NIRSQ-20

infections (SSIs). For every 25 patients discharged on an antiplatelet agent and a statin

medication, an additional 3.5 were alive at 5 years.

FY 2020 President’s Budget Policy: The FY 2020 Request for Patient Safety research is $65.3

million, a decrease of $7.0 million from the FY 2019 Enacted level.

In FY 2020, Research related to Risk and Harms will total $28.4 million, a decrease of $3.0

million from the FY 2019 Enacted level. The FY 2020 budget will fund $17.9 million in

continuing grants, $0.7 million in new grants, and $9.8 million in research contracts. With FY

2020 resources, AHRQ will continue to fund $10.0 million for the PSLLs to use system’s

engineering approaches to reduce patient harm due to treatment and diagnostic errors. NIRSQ

will not have the funding to continue to support diagnostic safety grants awarded in FY 2019.

Under this RFA, grantees have partnered with other organizations in order to more fully utilize

currently available sources of data and analytics to examine patterns in the diagnostic process

and the incidence of diagnostic errors for different clinical conditions and in different

populations and healthcare settings as well determine the impact of such errors on patient harm,

cost, expenditures, and utilization. We will also continue to fund grants that seek to address

challenges associated with opioids. The Medicare Patient Safety Monitoring System (MPSMS)

is being used to help understand the extent of medical errors taking place in U.S. hospitals.

AHRQ is developing and testing an improved patient safety surveillance system to replace

MPSMS that is known as the Quality and Safety Review System (QSRS). QSRS will generate

adverse event rates, trend performance over time, and unlike MPSMS, QSRS was designed to

also serve as a local hospital and health system tool to identify and measure adverse events to

inform safety improvement projects. In FY 2020, AHRQ anticipates making QSRS available to

hospitals.

Within the overall patient safety budget, FY 2020 funds totaling $32.5 million, a decrease of

$3.5 million from the FY 2019 Enacted level will support research grants and contracts to

advance the generation of new knowledge and promote the application of proven methods for

preventing Healthcare-Associated Infections (HAIs). Within this amount, $12.0 million will be

invested in support of the national Combating Antibiotic-Resistant Bacteria (CARB) enterprise.

AHRQ will fund research grants and implementation projects to further expand efforts to

develop and apply improved approaches for combating antibiotic resistance. Program activities

will include efforts in antibiotic stewardship, with a focus on ambulatory and long-term care

settings, as well as hospitals. In FY 2020, AHRQ’s Safety Program for Improving Antibiotic

Use, which is applying CUSP to promote implementation of antibiotic stewardship, will continue

to expand its reach beyond earlier cohorts of hospitals and long-term care facilities to address

antibiotic stewardship in ambulatory settings, using FY 2019 funds. AHRQ will also continue to

expand the CUSP projects aimed at reducing central line-associated blood stream infections

(CLABSI) and catheter-associated urinary tract infections (CAUTI) in intensive care units

(ICUs) with elevated level of these infections, and enhancing care and recovery of surgical

patients, using FY 2019 funds. In early FY 2020, AHRQ will assess the history and experience

with AHRQ’s CUSP projects to date, as well as then-current HAI and antibiotic resistance

issues, to determine which new CUSP project to initiate. A potential FY 2020 project that is

envisioned is CUSP for Clostridioides difficile (C. diff), a stubbornly persistent HAI related to

antibiotic use (see Program Portrait on the following page). The evidence and products of the

NIRSQ-21

CUSP projects are shared with other HHS OPDIVs. CDC and CMS staff serve on the Technical

Expert Panels of these projects and are involved in the development and dissemination of toolkits

that are produced by the projects.

Finally, AHRQ will provide $4.4 million to continue conformance with administrative

requirements of the Patient Safety Act (2005), a decrease of $0.5 million from the prior year.

The Patient Safety Act (2005) provides protection (legal privilege) to health care providers

throughout the country for quality and safety improvement activities. The Act promotes

increased voluntary patient safety event reporting and analysis, as patient safety work product

reported to a Patient Safety Organization (PSO) is protected from disclosure in medical

malpractice cases. HHS issued regulations to implement the Patient Safety Act, which

authorized the creation of PSOs, and AHRQ administers the provisions of the Patient Safety Act

dealing with PSO operations.

Program Portrait: Comprehensive Unit-based Safety Program (CUSP) – Assessment to identify one potential

project:

1. CUSP for Clostridioides difficile (C. diff)

FY 2019 Enacted Level: $10.6 million

FY 2020 President’s Budget Level: $ 5.2 million

Change: -$ 5.4 million

The Comprehensive Unit-based Safety Program (CUSP), which was both developed and shown to be effective with

AHRQ funding, involves improvement in safety culture, teamwork, and communication, together with a checklist of

evidence-based safety practices. CUSP was highly effective in reducing central line-associated blood stream

infections in more than 1,000 ICUs that participated in AHRQ’s nationwide CUSP implementation project for

central line-associated blood stream infections. Subsequently, AHRQ expanded the application of CUSP to prevent

other HAIs, including catheter-associated urinary tract infections in hospitals and long-term care facilities, surgical

site infections and other surgical complications in inpatient and ambulatory surgery, and ventilator-associated

events.

AHRQ will provide $5.2 million for CUSP activities in FY 2020, a decrease of $5.4 million from the prior year.

This decrease does not reflect a reduced interest in CUSP implementation. Instead, the decrease is related to two

factors. The first is the $3.5 million reduction from the FY 2019 Enacted level in the overall funding of the HAI

Program. The second is related to the stage of CUSP funding. The FY 2020 CUSP project is new in FY 2020 and

AHRQ anticipates higher second year costs for this implementation project.

In FY 2020, AHRQ’s three current CUSP projects will continue their expansion efforts. AHRQ’s Safety Program

for Improving Antibiotic Use, which is applying CUSP to promote implementation of antibiotic stewardship, will

continue to expand its reach beyond earlier cohorts of hospitals and long-term care facilities to address antibiotic

stewardship in ambulatory settings, using FY 2019 funds. AHRQ will also continue to expand the CUSP project

aimed at reducing central line-associated blood stream infections (CLABSI) and catheter-associated urinary tract

infections (CAUTI) in intensive care units (ICUs) with elevated level of these infections, as well as the CUSP

project for enhancing care and recovery of surgical patients, using FY 2019 funds.

In early FY 2020, AHRQ will assess the history and experience with AHRQ’s CUSP projects to date, as well as

then-current HAI and antibiotic resistance issues, to determine which new CUSP project to initiate. A potential FY

2020 project that is envisioned is CUSP for Clostridioides difficile (C. diff), a stubbornly persistent HAI that is

related to antibiotic use and that causes potentially fatal diarrhea. AHRQ will assess the appropriateness of applying

the CUSP method to this problem and will complete the planning of the project and its funding with FY 2020 funds.

NIRSQ-22

Mechanism Table:

5-Year Funding Table:

FY 2016: $74,253,000

FY 2017: $70,276,000

FY 2018 Final : $69,447,000

FY 2019 Enacted Level: $72,276,000

FY 2020 President’s Budget Level: $65,276,000

RESEARCH GRANTS No. Dollars No. Dollars No. Dollars

Non-Competing………………………………………………..50 21,612 62 24,073 85 33,573

New & Competing………………………. 36 13,766 37 14,044 18 7,000

Supplemental.....................................................…………..0 0 0 0 0 0

TOTAL, RESEARCH GRANTS..................................…………..86 35,378 99 38,117 103 40,573

TOTAL CONTRACTS/IAAs......................................…………………. 34,069 34,159 24,703

TOTAL........................................................…………………………. 69,447 72,276 65,276

NIRSQ

FY 2020

President's Budget

1/ For this and all other tables, the FY 2018 and FY 2019 columns contain information about the Agency for Healthcare Research and Quality

(AHRQ) and are provide for convenience and transparency. The FY 2020 President's Budget consolidates AHRQ into the National Institutes of

Healh (NIH), and the FY 2020 column represents the request for the National Institute for Research on Safety and Quality.

Patient Safety 1/


AHRQ

FY 2018

Final

AHRQ

FY 2019

Enacted

NIRSQ-23



Allocation Method………………......Competitive Grant/Cooperative Agreement, Contracts, and Other.

Health Services Research, Data, and Dissemination (HSR): The principle goals of HSR are

to identify the most effective ways to organize, manage, finance, and deliver high quality care,

reduce medical errors, and improve patient safety. The portfolio first conducts research to

identify the most pressing questions faced by clinicians, health system leaders, policy makers

and others about how to best provide the care patients need, together with appropriate solutions.

These questions include ones about how hospitals can address life threatening infections in their

intensive care units to how primary care practices can find and use the best evidence to reduce

their patients’ chances of developing heart disease or having a stroke. It also includes questions

about critical public health crises, such as the nation’s opioids epidemic. This research is done

both through investigator-initiated and directed research grants programs, as well as through

research contracts.

The next step in the HSR continuum is to implement the findings of our research. AHRQ

supports the implementation of its research findings by creating practical tools and resources that

can be used in real-world settings by professionals on the front lines of health care and policy

making. For instance, AHRQ has developed a model program for shared decision making

between clinicians and their patients, along with creating modules to train physicians and nurses

on using the program and training others to use it, as well. In addition, AHRQ ensures that these

kinds of resources are widely available by working with partners inside and outside of HHS

through public-private partnerships that maximize AHRQ’s expertise by leveraging these

organizations own networks and members.

Finally, AHRQ creates and disseminates data and analyses of key trends in the quality, safety,

and cost of health care to help users understand and respond to what is driving the delivery of

care today. These data and analyses take the form of statistical briefs, interactive presentations of

information on a national and state-by-state basis, infographics, and articles and commentaries in

leading clinical and policy outlets. AHRQ also develops measures of safety and quality that are

used to track changes in quality, safety, and health care costs over time, providing benchmarks

and dashboards for judging the effectiveness of clinical interventions and policy changes. AHRQ

not only provides National data sets and analyses, but where possible, AHRQ provides insights

on the State and local levels, too.

FY 2018


FY 2020

President's Budget

FY 2020 +/-

FY 2019

BA 94,284,000$ 96,284,000$ 57,942,000$ (38,342,000)$

HCQO: Health Services Research, Data and Dissemination

NIRSQ-24

Health Services Research, Data and Dissemination (HSR)

(in millions of dollars)

FY 2018

Final

FY 2019

Enacted

FY 2020

President’s

Budget Health Services Research Grants

(Investigator-Initiated)

$58.109

($52.874)

$57.723

($52.933)

$42.922

($42.922)

Health Services Contract/IAA Research $14.000 $14.000 $5.250

Measurement and Data Collection $14.410 $14.377 $9.700

Dissemination and Implementation $7.765 $10.184 $0.000

Total, HSR $94.284 $96.284 $57.942

Health Services Research Grants: Health Services Research grants, both targeted and

investigator-initiated, focus on research in the areas of quality, effectiveness and efficiency.

These activities are vital for understanding the quality, effectiveness, efficiency, and

appropriateness of health care services. Investigator-initiated research is particularly important.

New investigator-initiated research and training grants are essential to health services research –

they ensure that both new ideas and new investigators are created each year. Investigator-

initiated research grants allow extramural researchers to pursue the various research avenues that

lead to successful yet unexpected discoveries. In this light, the investigator-initiated grant

funding is seen as one of the most vital forces driving health services research in this country.

The FY 2018 Enacted provided $52.9 million for this activity. The FY 2019 Enacted maintains

this level of support. In addition, the FY 2019 Enacted level provides $2.0 million in targeted

funding for population health research.

FY 2020 President’s Budget Policy: The FY 2020 President’s Budget provides $42.9 million

for research grants, a decrease of $14.8 million from the FY 2019 Enacted level. The entirety of

this budget supports investigator-initiated grants. A total of $39.9 million supports non-

competing research grants, which are continuations of prior year awards. The FY 2020

President’s Budget does not include noncompeting support for AHRQ’s two directed research

programs: Consumer Assessment of Healthcare Providers and Systems (CAHPS) and population

health grants.

Support for new research and training grants totals $3.1 million. The entirety of AHRQ’s new

research grant funding is directed to new investigator-initiated research grants focused on two of

the nation’s most pressing health care issues: Opioid Abuse (+$1.5 million) and Transforming to

Value-based Delivery (+$1.5 million). In 2018, AHRQ is working with health care delivery

system leaders and the health services research community to identify and prioritize the most

critical areas for research in these areas. Potential targets for opioids research include the need

for health system interventions to prevent addiction among people who have experimented with

opioids and utilizing mobile apps to provide behavioral support to compliment medication

assisted therapy. In the field of value, the ability to incorporate social determinants of health into

clinical decision making and utilizing clinical data to improve health system performance are

emerging as potential areas of focus. Through active stakeholder engagement, AHRQ will be

well prepared to create targeted funding announcements in FY 2019 and NIRSQ will fund

innovative health services research to address critical research gaps in FY 2020. AHRQ will

NIRSQ-25

utilize its standard competitive health service research mechanisms to solicit and fund these

research grants.

Health Services Contracts/IAA Research: Similar to support of research grants, funding of

health services contracts and IAAs support health services research activities that impact quality,

effectiveness and efficiency of health care. An example of an HSR contract is support for the

Evidence-Based Practice Center (EPC) program. The EPCs review all relevant scientific

literature on a wide spectrum of clinical and health services topics to produce various types of

evidence reports that are widely used by public and private health care organizations. These

reports may be used for informing and developing coverage decisions, quality measures,

educational materials and tools, clinical practice guidelines, and research agendas. This research

activity also funds HSR implementation research contracts, data security, data analytics, peer

review of research grants, and contracts that support public access to research results. The FY

2019 funding for Health Services Contracts/IAAs is $14.0 million.

FY 2020 President’s Budget Policy: The FY 2020 Request provides $5.25 million for this

activity, a decrease of $8.75 million from the FY 2019 Enacted level. This funding will provide

$0.75 million in funding for EPCs. In addition, the FY 2020 President’s Budget will provide

$4.5 million to support research related to the Secretarial initiative to Address Prescription Drug

and Opioid Misuse and Abuse. NIRSQ’s funding will accelerating evidence on preventing and

treating opioid abuse in primary care, especially in older adults. One exciting component of this

research is the development and pilot testing of innovative models of care to address opioid

misuse in older adults. In total, the FY 2020 President’s Budget provides $6.0 million in funding

to support the Secretary’s initiative to combat opioid abuse, misuse, and overdose - $1.5 million

in new research grants and $4.5 million in contract support.

Measurement and Data Collection: Monitoring the health of the American people is an

essential step in making sound health policy and setting research and program priorities. Data

collection and measurement activities allow us to document the quality and cost of health care,

track changes in quality or cost at the national, state, or community level; identify disparities in

health status and use of health care by race or ethnicity, socioeconomic status, region, and other

population characteristics; describe our experiences with the health care system; monitor trends

in health status and health care delivery; identify health problems; support health services

research; and provide information for making changes in public policies and programs. AHRQ’s

Measurement and Data Collection Activity coordinates AHRQ data collection, measurement and

analysis activities across the Agency. In FY 2018 AHRQ provided $14.4 million to support

measurement and data collection activities including the following flagship projects: Healthcare

Cost and Utilization Project (HCUP), Consumer Assessment of Healthcare Providers and

Systems (CAHPS), AHRQ Quality Indicators (AHRQ QIs), and the National Healthcare

Disparities and Quality Reports (QDRs). The FY 2019 Enacted continues these programs.

FY 2020 President’s Budget Policy: The FY 2020 President’s Budget provides $9.7 million

for Measurement and Data Collection activities, a decrease of $4.6 million from the prior year.

This funding level will provide full funding for Healthcare Cost and Utilization Project (HCUP).

No funding is provided for Consumer Assessment of Healthcare Providers and Systems

NIRSQ-26

(CAHPS), AHRQ Quality Indicators (QIs), or the National Healthcare Disparities and Quality

Reports (QDRs). For more information about HCUP please see the program portrait on page 30.

Dissemination and Implementation: AHRQ’s dissemination and implementation activities

foster the use of Agency-funded research, products, and tools to achieve measurable

improvements in the health care patients receive. AHRQ research, products, and tools are used

by a wide range of audiences, including individual clinicians; hospitals, health systems, and other

providers; patients and families; payers, purchasers, and health plans; and Federal, state, and

local policymakers. AHRQ’s dissemination and implementation activities are based on

assessments of these audiences’ needs and how best to foster use of Agency products and tools,

plus sustained work with key stakeholders to develop ongoing dissemination partnerships. In

addition, AHRQ sponsors the dissemination of research findings and tools through tailored,

hands-on technical assistance. Support for Dissemination and Implementation activities is $10.2

million at the FY 2019 Enacted level.

FY 2020 President’s Budget Policy: The FY 2020 President’s Budget ends support for

dissemination and implementation activities as a result of the consolidation with NIH. NIRSQ

will end outreach to stakeholders, advocacy and intermediary groups that impact adoption of new

findings by end users; vital toolkits used by front-line clinicians; and reduce direct contact with

health care industry leaders by attending and exhibiting at their professional meetings. The

elimination of dissemination and implementation support will impact the Agency’s ability to

communicate with physicians, nurses, hospital, and health systems leaders, states, and others.

Prior support for dissemination and implementation activities has allowed AHRQ to make more

widely available the tools and interventions that have led to reductions in hospital-acquired

conditions, preventing 350,000 infections, preventing 8,000 deaths, and saving $2.9 billion in

care costs from 2014 to 2016.

NIRSQ-27

Program Portrait: Healthcare Cost and Utilization Project (HCUP) - $9.7 million

HCUP is the Nation’s most comprehensive source of hospital care data, including information on in-patient stays,

ambulatory surgery and services visits, and emergency department encounters. HCUP enables researchers, insurers,

policymakers and others to study health care delivery and patient outcomes over time, and at the national, regional,

State, and community levels. This program develops HCUP Statistical Briefs – these briefs present simple,

descriptive statistics on a variety of topics including specific medical conditions as well as hospital characteristics,

utilization, quality, and cost.

Data from HCUP are used to document dramatic increases in inpatient hospitalizations and emergency department

visits related to opioid use. AHRQ is publishing a series of Statistical Briefs that provide descriptive information on

opioid-related hospital use by select patient subgroups. A recent report showed that opioid misuse in older adults is

an underappreciated and growing problem. Between 2010 and 2015, the number of opioid-related inpatient stays

increased over 54 percent among patients aged 65 years and older, from 80,500 stays in 2010 to 124,300 stays in

2015, with the largest increase among patients aged 65–74 years. Similarly, between 2010 and 2015, the number of

opioid-related emergency department visits doubled among patients aged 65 years and older, from 18,100 visits in

2010 to 36,200 visits in 2015. Please see the graphs below.

Please visit the HCUP website for more information.

https://www.hcup-us.ahrq.gov/reports/statbriefs/sb224-Patient-Characteristics-Opioid-Hospital-Stays-ED-Visits-by-State.jsp

NIRSQ-28

Mechanism Table:


FY 2016: $ 89,398,000

FY 2017: $ 88,731,000

FY 2018 Final: $ 94,284,000

FY 2019 Enacted: $ 96,284,000

FY 2020 President’s Budget: $ 57,942,000


Non-Competing………………………………………………..155 41,990 155 40,952 144 39,860

New & Competing………………………. 95 16,119 74 16,771 14 3,132

Supplemental.....................................................…………..0 0 0 0 0 0

TOTAL, RESEARCH GRANTS..................................…………..250 58,109 229 57,723 158 42,992


TOTAL........................................................…………………………. 94,284 96,284 57,942




FY 2019

Enacted President's Budget


AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

Health Services Research, Data and Dissemination 1/

FY 2020

Final

AHRQ

FY 2018

NIRSQAHRQ

NIRSQ-29



Allocation Method………………............................................................................. Contracts, and Other.

U.S. Preventive Services Task Force (USPSTF): The U.S. Preventive Services Task Force

(USPSTF) is an independent, volunteer panel of nationally-recognized experts in prevention and

evidence-based medicine. The Task Force makes evidence-based recommendations about

clinical preventive services to improve the health of all Americans (e.g., by improving quality of

life and prolonging life). Since 1998, AHRQ has been authorized by Congress to provide

ongoing scientific, administrative and dissemination support to assist the USPSTF in meeting its

mission. AHRQ is the sole funding source of the USPSTF. AHRQ supports the USPSTF by

ensuring that it has: the evidence it needs in order to make its recommendations; the ability to

operate in an open, transparent, and efficient manner; and the ability to clearly and effectively

share its recommendations with the health care community and general public.

Major FY 2018 accomplishments for the USPSTF include:

Maintained recommendation statements for 83 preventive service topics with 133 specific

recommendation grades. Many recommendation statements include multiple

recommendation grades for different populations.

Received 15 nominations for new topics and 6 nominations to reconsider or update

existing topics.

Posted 11 draft research plans for public comments.

Posted 13 draft recommendation statements for public comments.

Posted 13 draft evidence reports for public comments.

Published 15 final recommendation statements in a peer-reviewed journal.

To do its work, the Task Force uses a four-step process:

1. Step 1: Topic Nomination. Anyone can nominate a new topic or an update to an existing

topic at any time, via the Task Force Web site.

2. Step 2: Draft and Final Research Plans. The Task Force develops a draft research plan

for the topic, which is posted on the Task Force Web site for a 4-week public comment

period. The Task Force reviews and considers all comments as it finalizes the research

plan.

3. Step 3: Draft Evidence Review and Draft Recommendation Statement. The Task

Force reviews all available evidence on the topic from studies published in peer-reviewed

scientific journals. The evidence is summarized in the draft evidence review and used to

develop the draft recommendation statement. These draft materials are posted on the

Task Force Web site for a 4-week public comment period.

4. Step 4: Final Evidence Review and Final Recommendation Statement. The Task

Force considers all comments on the draft evidence review and recommendation

statement as it finalizes the recommendation statement.

FY 2018


FY 2020

President's Budget

FY 2020 +/-

FY 2019

BA 11,649,000$ 11,649,000$ 7,400,000$ (4,249,000)$

HCQO: U.S. Preventive Services Task Force

NIRSQ-30

FY 2020 President’s Budget Policy: The FY 2020 Request for the USPSTF is $7.4 million, a

decrease of $4.3 million from the FY 2019 Enacted level. With these funds NIRSQ will

continue to maintain support for the Task Force, but at a reduced scope (including scientific,

methodological, and dissemination support). The FY 2020 President’s Budget will allow the

USPSTF to make recommendations on approximately 6 topics, 6 fewer than the historical

average for the Task Force.

Program Portrait: Recommendation on Screening for Prostate Cancer

Prostate cancer is one of the most common cancers to affect men. Many men with prostate cancer never experience

symptoms and, without screening, would never know they have the disease. Screening to detect and treat prostate

cancer in men without symptoms may offer benefits, but is also associated with harms.

Given the importance of prostate cancer, the USPSTF sought to update its 2012 recommendation. To do this, the

USPSTF commissioned a systematic review of the scientific evidence. Given that new research results are published

each year, it is critical for the USPSTF to review the latest scientific literature. The USPSTF used the evidence from

the systematic review to develop its recommendation, including examining the evidence for specific populations

(e.g., men with a family history and African American men) and specific age groups (men younger than 55, between

55 and 69, and those aged 70 and older).

The USPSTF is committed to transparency when developing its recommendations. Therefore, it also sought input on

its draft recommendation from the public, topic experts and clinical specialists, patients, and other stakeholders. The

USPSTF also worked closely with other Federal agencies, as well as professional organizations that deliver care.

The USPSTF reviewed and considered all of this input when finalizing its recommendations.

To help ensure that clinicians, patients, and other stakeholders are aware of and understand the USPSTF’s new

recommendation, the USPSTF used several communication and dissemination strategies. It developed an

infographic to explain the benefits and harms of screening for prostate cancer, which has been widely used by

clinicians, patients, and other stakeholders. The USPSTF also developed a video to help explain the

recommendation statement to clinicians and patients in plain language. It also conducted briefings for stakeholders,

including patient advocacy groups, prostate cancer specialists, and other medical groups.

The final recommendation was published in the Journal of the American Medical Association in May 2018. It

received a lot of national attention with over 50,000 page views on the website at the time of the release, with

extensive media coverage in over 600 news articles. For example, it received coverage from media outlets including

Reuters, The Los Angeles Times, The Associated Press, ABC, CNN and CBS.

NIRSQ-31

Mechanism Table:


FY 2016: $11,649,000

FY 2017: $11,649,000

FY 2018 Final: $11,649,000

FY 2019 Enacted $11,649,000

FY 2020 Request: $ 7,400,000


Non-Competing………………………………………………..0 0 0 0 0 0

New & Competing………………………. 0 0 0 0 0 0

Supplemental.....................................................…………..0 0 0 0 0 0

TOTAL, RESEARCH GRANTS..................................…………..0 0 0 0 0 0


TOTAL........................................................…………………………. 11,649 0 11,649 0 7,400




AHRQ

FY 2019

AHRQ NIRSQ

FY 2020

President's BudgetEnactedFinal

FY 2018

U.S. Preventive Services Task Force 1/


NIRSQ-32


FY 2020 Authorization………………….……..…………………………………………..………Expired.

Allocation Method…………..……............................................................................. Contracts and Other.

Medical Expenditure Panel Survey (MEPS): MEPS, first funded in 1995, is the only national

source for comprehensive annual data on how Americans use and pay for medical care. The

MEPS is designed to provide annual estimates at the national level of the health care utilization,

expenditures, sources of payment and health insurance coverage of the U.S. civilian non-

institutionalized population. The funding requested primarily supports data collection and

analytical file production for the MEPS family of interrelated surveys, which include a

Household Component (HC), a Medical Provider Component (MPC), and an Insurance

Component (IC). In addition to collecting data that support annual estimates for a variety of

measures related to health insurance coverage, healthcare use and expenditures, MEPS provides

estimates of measures related to health status, demographic characteristics, employment, access

to health care and health care quality. The survey also supports estimates for individuals,

families and population subgroups of interest. The data collected in this ongoing longitudinal

study also permit studies of the determinants of insurance take-up, use of services and

expenditures as well as changes in the provision of health care in relation to social and

demographic factors such as employment and income; the health status and satisfaction with care

of individuals and families; and the health needs of specific population groups such as racial and

ethnic minorities, the elderly and children.

MEPS data continue to be essential for the evaluation of health policies and analysis of the

effects of tax code changes on health expenditures and tax revenue. Key data uses include:

MEPS IC data are used by the Bureau of Economic Analysis in computing the nation’s

GDP

MEPS HC and MPC data are used by the Congressional Budget Office, Congressional

Research Service, the Treasury and others to inform high level inquiries related to

healthcare expenditures, insurance coverage and sources of payment

MEPS is used extensively to inform policymakers with respect to the Children’s Health

Insurance Program and its reauthorization

MEPS is used extensively by the GAO in its studies of the U.S. healthcare system and

subsequent reports as requested by the Senate Committee on Health, Education, Labor

and Pensions

MEPS is used by CMS to inform the National Health Expenditure Accounts

MEPS is used extensively by the health services research community as the primary source of

high quality national data for studies related to healthcare expenditures and out-of-pocket costs

and examinations of expenditures related to specific types of health conditions.

FY 2018


FY 2020

President's Budget

FY 2020 +/-

FY 2019

BA 69,991,000$ 69,991,000$ 71,791,000$ 1,800,000$

Medical Expenditure Panel Survey

NIRSQ-33

FY 2020 President’s Budget Policy: The FY 2020 President’s Budget level for the MEPS is

$71.8 million, an increase of $1.8 million from the FY 2019 Enacted level. A total of $70.0

million is required for base funding. Base funding will allow NIRSQ to continue to provide

ongoing support to the MEPS, allowing the survey to maintain the precision levels of survey

estimates, maximize survey response rates, and the timeliness, quality and utility of data products

specified for the survey in prior years.

An additional $1.8 million will be directed to expanding the capacity of the MEPS to address

HHS priorities. By both augmenting the sample by 1,000 completed households (2,300 persons)

and by redistributing sample across states, MEPS will improve its national estimates and increase

our capacity for making estimates of individual states and groups of states, particularly rural

states and those with relatively small populations. An additional 1,000 completed household

interviews could be used to produce improvements in the precision of State level estimates for

about 36 States and D.C. (i.e. all except the 7 largest and 7 smallest States). This augmentation

will also enhance the ability of MEPS to support analyses of key population subgroups, such as

persons with specific conditions and those at particular income levels or age groups, as well as

analyses by insurance status. In the implementation of this investment, MEPS will engage with

organizations with interest and expertise in state health matters, such as the State Health Access

Data Assistance Center (SHADAC), the National Governors Association (NGA), the National

Council of State Legislators (NCSL), and National Association of Counties (NACo) to assist

with dissemination activities. The enhanced data will also be disseminated through the

program’s existing extensive network of users, which includes numerous universities, research

organizations, and national, state, and local agencies and organizations. ($1.8 million in FY 2020

with out year costs of $1.1 million in FY 2021 and $0.590 million in FY 2022.)

This initiative will provide increased capacity to examine medical care access, use, spending and

health outcomes both across states and for population subgroups, which will enhance

researchers’ and policymakers’ ability to bring comprehensive data to bear on policy questions

related HHS priority issues. This enhancement to the MEPS will make it an even more powerful

tool for state and federal policy and decision makers. For example, it will improve the utility of

the MEPS for examinations of medical care utilization and expenditures across states, allowing

more precise comparisons across more states and regions, and provide a more solid basis for

predicting the impact of state level policy changes on programs such as Medicaid and CHIP.

Improvements to these programs will have a positive impact on system efficiency and outcomes,

which can improve the value of care provided and increase the quality of care for patients.

NIRSQ-34

Mechanism Table:


FY 2016: $66,000,000

FY 2017: $66,000,000

FY 2018 Final: $69,991,000

FY 2019 Enacted: $69,991,000

FY 2020 President’s Budget: $71,791,000


Non-Competing………………………………………………..0 0 0 0 0 0

New & Competing………………………. 0 0 0 0 0 0

Supplemental.....................................................…………..0 0 0 0 0 0



TOTAL........................................................…………………………. 69,991 69,991 71,791




NIRSQ

FY 2020

President's Budget

MEPS Mechanism Table 1/


FY 2019

Enacted

AHRQAHRQ

Final

FY 2018

NIRSQ-35

Program Portrait: Medical Expenditure Panel Survey (MEPS)

FY 2019 Enacted Level: $69.991 million

FY 2020 Request Level: 71.791 million

Change: +$1.800 million

The MEPS Household Component (HC) collects nationally representative information on demographic

characteristics, socioeconomic status, health insurance status, access to care, health status, chronic conditions and use

of health care services that can be used to examine a broad range of important health issues. The MEPS Insurance

Component (IC) is an annual survey of private employers and State and local governments and is designed to provide

data representative of all 50 States and the District of Columbia on topics including the number and types of private

health insurance plans offered, plan benefits, annual premiums, employer and employee premium contributions, and

employer characteristics. Following are key findings from recent research that used the MEPS HC and the MEPS IC

to address topics relevant to Secretarial priorities regarding opioids, health insurance reform and value-based care.

Key Findings

Use of Outpatient Prescription Opioids (using data from the MEPS HC):

In 2015-2016, 19.3 percent of elderly adults and 13.0 percent of non-elderly adults, on average, filled at least

1 outpatient opioid prescription, and 7.1 percent of elderly adults and 3.1 percent of non-elderly adults

obtained 4 or more prescription fills during the year.

The average annual rates of any outpatient opioid use increased as health status declined, ranging from 8.8

percent for elderly adults in excellent health to 39.4 percent for those in poor health, and ranging from 6.1

percent for non-elderly adults in excellent health to 45.4 percent for those in poor health.

Elderly adults who were poor (9.5percent) or low income (11.3 percent) were more likely than middle-

income (6.8 percent) and high-income (4.5 percent) elderly adults to obtain 4 or more opioid prescription fills

during the year.

Non-elderly adults who had family incomes below the federal poverty line (18.5 percent), lived in rural areas

(16.5 percent), or were covered by public insurance due to a disability (38.7 percent) were more likely than

others to have at least one opioid prescription fill during the year.

These results can contribute to efforts to make appropriate use of outpatient prescription opioids which can

be effective in relieving pain, but also carry serious risks of opioid use disorder and overdose.

State Variations in Employer-Sponsored Insurance (using MEPS IC data on private sector workers):

In 2017, average health insurance premiums for enrollees in private-sector employer plans were $6,368 for

single coverage, $12,789 for employee-plus-one coverage, and $18,687 for family coverage. Five States

(Arkansas, Idaho, Nevada, Tennessee, and Utah) had average annual premiums that were significantly lower

than the national average for all three types of coverage. Six States (Alaska, Connecticut, Massachusetts,

New Jersey, New York, and Wyoming) had average annual premiums that were significantly higher than the

national average for all three types of coverage.

Offer rates among small firms with fewer than 50 employees are an important factor contributing to overall

State offer rates because almost all large firms offer health insurance coverage. Nationwide, nearly half (48

percent) of employees of small firms worked at establishments that offered insurance in 2017. In eight States,

small-employer offer rates were above the national average, including Massachusetts (66%), the District of

Columbia (67%), and Hawaii (89%). In 10 States, small-employer offer rates were below the national

average, including Alaska (31%), Arkansas (34%), North Carolina (34%), and Utah (34%).

From 2004 to 2017, the percentage of single enrollees in high deductible health plans (HDHPs) increased

from 12 percent to 53 percent and the percentage of family enrollees increased from 9 percent to 52 percent.

In ten states, the percent of single enrollees in HDHPs was below the national average, including Hawaii

(11%), the District of Columbia (35%), and California (38%). In 16 states, the share was above the national

average, including Maine (67%), South Dakota (73%), and New Hampshire (76%).

These results can inform efforts to improve availability and affordability of employment-based insurance.

NIRSQ-36


FY 2020 Authorization………………….……..…………………………………………..………Expired.

Allocation Method…………..…….................................................................................................... Other.

Research Management and Support (RMS): RMS (formerly known as Program Support)

activities provide administrative, budgetary, logistical, and scientific support in the review,

award, and monitoring of research grants, training awards, and research and development

contracts. RMS functions also encompass strategic planning, coordination, and evaluation of the

Institute’s programs, regulatory compliance, international coordination, and liaison with other

Federal agencies, Congress, and the public.

FY 2020 President’s Budget Policy: The FY 2020 President’s Budget level for Research

Management and Support (RMS) is $53.5 million, a decrease of $17.7 million from the FY 2019

Enacted level. In FY 2020, the reorganization transitioned AHRQ activities to the NIH as an

Institute and ended some programmatic activities. This reduction in scope necessitated a

decrease of 39 FTEs funded with discretionary accounts at the 2019 Enacted level. The FY 2020

President’s Budget for Research Management and Support provides necessary one-time support

related to close-out activities for research that is ending and workforce reduction expenses, as

well as ongoing research management costs related to moving AHRQ’s activities to the National

Institute of Health (NIH).

As shown below, AHRQ does have additional FTEs supported with other funding sources,

including an estimated 1 FTE from other reimbursable funding and an estimated 7 FTEs

supported by the Patient-Centered Outcomes Research Trust Fund. The estimate for the

PCORTF is preliminary and will be finalized once activities are decided for FY 2020.

FY 2018 Final FY 2019

Enacted

FY 2020

President’s

Budget

FTEs – Budget Authority 269 276 237

FTEs – PCORTF 8 7 7

FTEs – Other Reimbursable 4 1 1

FY 2018


FY 2020

President's Budget

FY 2020 +/-

FY 2019

BA 71,300,000$ 71,300,000$ 53,551,000$ (17,749,000)$

FTE 273 277 238 -39

Research Management and Support

NIRSQ-37

Mechanism Table:

5-Year Funding History:

FY 2016: $71,200,000

FY 2017: $70,844,000

FY 2018 Final: $71,300,000

FY 2019 Enacted: $71,300,000

FY 2020 President’s Budget: $53,551,000


Non-Competing………………………………………………..0 0 0 0 0 0

New & Competing………………………. 0 0 0 0 0 0

Supplemental.....................................................…………..0 0 0 0 0 0


TOTAL CONTRACTS/IAAs......................................…………………. 0 0 0

RESEARCH MANAGEMENT………. 71,300 71,300 53,551

TOTAL........................................................…………………………. 71,300 71,300 53,551




FY 2019

NIRSQ

Enacted

AHRQ

Research Management and Support (Program Support)

(Dollars in Thousands) 1/

AHRQ

FY 2020

President's Budget

FY 2018

Final

NIRSQ-38

Nonrecurring Expenses Fund

Budget Summary


FY 20182 FY 20193/4 FY 20205

Notification1 -- $1,500 TBD

Authorizing Legislation:

Authorization…………Section 223 of Division G of the Consolidated Appropriations Act, 2008

Allocation Method…….…………………….……………..Direct Federal, Competitive Contract

Program Description and Accomplishments:

The Nonrecurring Expenses Fund (NEF) permits HHS to transfer unobligated balances of

expired discretionary funds from FY 2008 and subsequent years into the NEF account. Congress

authorized use of the funds for capital acquisitions necessary for the operation of the

Department, specifically information technology (IT) and facilities infrastructure acquisitions.

As mandated by Congress, AHRQ produces an annual comprehensive overview of the quality of

U.S health care and disparities in that care. The National Healthcare Quality and Disparities

Report (QDR) serves as the Nation’s dashboard on healthcare quality, disparities, and patient

safety for Congress, state and local policymakers, and public health officials. It currently

consists of a suite of resources including a core report, chart books on select topics, a website

that features information for national benchmarks and state-level snapshots, and a basic online

data query system. The NEF will support a one-time investment to upgrade the QDR IT

platform. AHRQ will transition the current QDR to an interactive and integrated online

dashboard incorporating national, state and local statistics from across HHS. It will serve as a

flexible and interactive tool that has the capacity to add new dashboards that support HHS and

Secretarial Priority areas in order to inform decision-makers in a timely manner.

The goal of the QDR is to assess the performance of our health care system and identify areas of

strengths and weaknesses, as well as disparities, for access to health care and quality of health

care. The current QDR includes more than 250 measures of quality and disparities covering a

broad array of health care services and settings. NEF funding will allow AHRQ to expand the

data capabilities of the QDR while unleashing the data for use by state and local decision

makers. The new QDR data platform will advance the nation’s efforts to improve health care

quality safety, and disparities by building on the strong foundation already established by

AHRQ. The entire healthcare ecosystem is data-driven and digitized. Hence, it is an operational

imperative that our QDR platform reflect that reality.

NIRSQ-39

The AHRQ QDR platform was built using technology that is more than a decade old. Given the

rapid technology advancements that has since occurred it requires a significant overhaul. In its

current state, it is difficult and costly to maintain and support. There is an urgent need to upgrade

the platform so that it can meet the requirements for real-time data and predictive analytics.

While the QDR has evolved over its 14 years, the data needs of health care decision makers and

the capacities of data platforms have also evolved. In order to maximize our annual federal

investment and meet the needs of Departmental, state, and local policy makers, AHRQ must

update the underlying data platform that powers the QDR. By advancing our data technology,

this one-time investment will expand the Agency’s ability to incorporate national data sources,

enhance real-time data query capacities and predictive analytics, thereby improving the

accessibility, utility, and timeliness of the QDR resources for Congress, HHS, and state and local

health care decision makers.

Additionally, the NEF has provided approximately $13 million to AHRQ for the development of

the Quality and Safety Review System (QSRS) to replace the antiquated Medicare Patient Safety

Monitoring System (MPSMS), which has been used by CMS and AHRQ to manually abstract a

sample of medical records to determine at national rate of hospital-acquired conditions. To date,

QSRS has been extensively tested by abstractors in the CMS Clinical Data Abstraction Center

(CDAC) and by approximately 10 hospitals in two hospital systems. With feedback received

from the CDAC and hospital pilots, AHRQ has continued to improve the validity and reliability

of QSRS, while enhancing usability. AHRQ has further developed QSRS to refine the

underlying algorithms to ensure correct measurement, and added data visualization functionality

among other enhancements in the past year.

Budget Allocation:

The development of the new QDR data platform will be funded in its entirety from NEF with the

operations and maintenance activities covered under AHRQ’s annual appropriation using

existing staffing and support contracts. AHRQ anticipates the project costs to be approximately

$1.5 million in FY 2019 including all planning, development, and deployment activities.

1 Pursuant to Section 223 of Division G of the Consolidated Appropriation Act, 2008, notification is required of planned use.

2 There was no Congressional notification for the planned uses of NEF funds in FY 2018.

3 Notification #6submitted to the Committee on Appropriations in the House of Representatives and the Senate on December 4, 2018.

4 Amounts notified are approximations of intended use. Amounts displayed here are current best estimates.

5HHS has not yet notified for FY 2020.

NIRSQ-40

FY 2018 Final

FY 2019

Enacted

FY 2020

President's

Budget

FY 2020 +/- FY

2019

Personnel compensation:

Full-time permanent (11.1).................................................. 30,438,301 30,648,547 26,107,731 (4,540,816)

Other than full-time permanent (11.3)............................... 3,559,006 3,575,911 3,052,653 (523,258)

Other personnel compensation (11.5)............................... 1,113,054 1,118,341 954,696 (163,645)

Military personnel (11.7)..................................................... 731,363 750,013 513,706 (236,307)

Special personnel services payments (11.8)....................

Subtotal personnel compensation................................ 35,841,724 36,092,812 30,628,785 (5,464,027)

Civilian benefits (12.1)............................................................. 10,687,229 10,737,993 7,942,065 (2,795,928)

Military benefits (12.2)............................................................ 333,686 342,195 219,091 (123,104)

Benefits to former personnel (13.0)...................................... 1,518,334 1,518,334

Total Pay Costs........................................................................ 46,862,639 47,173,000 40,308,276 (6,864,724)

Travel and transportation of persons (21.0)........................ 257,943 262,328 250,000 (12,328)

Transportation of things (22.0).............................................. 5,000 5,085 5,000 (85)

Rental payments to GSA (23.1).............................................. 3,233,669 3,288,641 2,800,000 (488,641)

Rental payments to Others (23.2)..........................................

Communication, utilities, and misc. charges (23.3)............. 129,249 131,446 100,000 (31,446)

Printing and reproduction (24.0)............................................ 25,136 25,563 25,000 (563)

Other Contractual Services:

Advisory and assistance services (25.1).........................

Other services (25.2)............................................................ 9,923,614 10,092,315 9,402,724 (689,591)

Purchase of goods and services from

government accounts (25.3)........................................... 20,350,470 20,696,428 11,701,458 (8,994,970)

Operation and maintenance of facilities (25.4)................

Research and Development Contracts (25.5).................. 142,392,758 144,215,766 110,323,886 (33,891,880)

Medical care (25.6)...............................................................

Operation and maintenance of equipment (25.7)............ 480,778 488,951 340,000 (148,951)

Subsistence and support of persons (25.8).....................

Subtotal Other Contractual Services.......................... 173,147,620 175,493,461 131,768,068 (43,725,393)

Supplies and materials (26.0).................................................. 120,868 122,923 120,000 (2,923)

Equipment (31.0)...................................................................... 1,138,220 1,157,570 200,000 (957,570)

Land and Structures (32.0) ....................................................

Investments and Loans (33.0)................................................

Grants, subsidies, and contributions (41.0)......................... 108,016,631 110,339,983 80,383,656 (29,956,327)

Interest and dividends (43.0).................................................

Refunds (44.0)..........................................................................

Total Non-Pay Costs............................................................... 286,074,336 290,827,000 215,651,724 (75,175,276)

Total Budget Authority by Object Class............................. 332,936,975 338,000,000 255,960,000 (82,040,000)

2/ Does not include mandatory financing from the PCORTF.



Budget Authority by Object 1/ 2/


Quality and are provided for convenience and transparency. The FY 2020 President’s Budget consolidates AHRQ’s activities into

NIH, and the FY 2020 column represents the request for the National Institute for Research on Safety and Quality.

NIRSQ-41

Salaries and Expenses 1/ 2/

FY 2018 Final

FY 2019

Enacted

FY 2020

President's

Budget

FY 2020 +/- FY

2019

Personnel compensation:

Full-time permanent (11.1).................................................. 30,438,301 30,648,547 26,107,731 (4,540,816)

Other than full-time permanent (11.3)............................... 3,559,006 3,575,911 3,052,653 (523,258)

Other personnel compensation (11.5)............................... 1,113,054 1,118,341 954,696 (163,645)

Military personnel (11.7)..................................................... 731,363 750,013 513,706 (236,307)

Special personnel services payments (11.8)....................

Subtotal personnel compensation................................ 35,841,724 36,092,812 30,628,785 (5,464,027)

Civilian benefits (12.1)............................................................. 10,687,229 10,737,993 7,942,065 (2,795,928)

Military benefits (12.2)............................................................ 333,686 342,195 219,091 (123,104)

Benefits to former personnel (13.0)...................................... 1,518,334 1,518,334

Total Pay Costs........................................................................ 46,862,639 47,173,000 40,308,276 (6,864,724)

Travel and transportation of persons (21.0)........................ 257,943 262,328 250,000 (12,328)

Transportation of things (22.0).............................................. 5,000 5,085 5,000 (85)

Communication, utilities, and misc. charges (23.3)............. 129,249 131,446 100,000 (31,446)

Printing and reproduction (24.0)............................................ 25,136 25,563 25,000 (563)

Other Contractual Services :

Other services (25.2)............................................................ 9,923,614 10,092,315 9,402,724 (689,591)

Operation and maintenance of equipment (25.7)............ 480,778 488,951 340,000 (148,951)

Subtotal Other Contractual Services.......................... 10,404,392 10,581,267 9,742,724 (838,543)

Supplies and materials (26.0).................................................. 120,868 122,923 120,000 (2,923)

Total Non-Pay Costs............................................................... 10,942,588 11,128,612 10,242,724 (885,888)

Total Salary and Expense....................................................... 57,805,227 58,301,612 50,551,000 (7,750,612)

Direct FTE................................................................................ 273 277 238 (39)




Quality and are provided for convenience and transparency. The FY 2020 President’s Budget consolidates AHRQ’s activities

into NIH, and the FY 2020 column represents the request for the National Institute for Research on Safety and Quality.

2/ Does not include mandatory financing from the PCORTF.

NIRSQ-42

2018

Actual

Civilian

2018

Actual

Military

2018

Actual

Total

2019

Est.

Civilian

2019

Est.

Military

2019

Est.

Total

2020

Est.

Civilian

2020

Est.

Military

2020

Est.

Total

Office of the Director (OD)

Direct:................................................................................................ 7 0 7 8 0 8 6 0 6

Reimbursable:.................................................................................. 0 0 0 0 0 0 0 0 0

Total:.............................................................................................. 7 0 7 8 0 8 6 0 6

Office of Management Services (OMS)

Direct:................................................................................................ 55 0 55 57 0 57 57 0 57

Reimbursable:.................................................................................. 1 0 1 0 0 0 0 0 0

Total:.............................................................................................. 56 0 56 57 0 57 57 0 57

Office of Extramural Research, Education, and Priority

Populations (OEREP)

Direct:................................................................................................ 31 2 33 33 2 35 33 1 34

Reimbursable:.................................................................................. 1 0 1 1 0 1 1 0 1

Total:.............................................................................................. 32 2 34 34 2 36 34 1 35

Center for Evidence and Practice Improvement (CEPI)

Direct:................................................................................................ 43 2 45 43 2 45 31 1 32

Reimbursable:.................................................................................. 1 0 1 0 0 0 0 0 0

Total:.............................................................................................. 44 2 46 43 2 45 31 1 32

Center for Delivery, Organization and Markets (CDOM)

Direct:................................................................................................ 25 0 25 27 0 27 20 0 20

Reimbursable:.................................................................................. 0 0 0 0 0 0 0 0 0

Total:.............................................................................................. 25 0 25 27 0 27 20 0 20

Center for Financing, Access, and Cost Trends (CFACT)

Direct:................................................................................................ 42 0 42 42 0 42 42 0 42

Reimbursable:.................................................................................. 1 0 1 0 0 0 0 0 0

Total:.............................................................................................. 43 0 43 42 0 42 42 0 42

Center for Quality Improvement and Patient Safety (CQuIPS)

Direct:................................................................................................ 31 2 33 31 2 33 29 2 31

Reimbursable:.................................................................................. 0 0 0 0 0 0 0 0 0

Total:.............................................................................................. 31 2 33 31 2 33 29 2 31

Office of Communications and Knowledge Transfer (OCKT)

Direct:................................................................................................ 29 0 29 29 0 29 15 0 15

Reimbursable:.................................................................................. 0 0 0 0 0 0 0 0 0

Total:.............................................................................................. 29 0 29 29 0 29 15 0 15

AHRQ FTE Total.............................................................................. 267 6 273 271 6 277

NIRSQ FTE Total............................................................................. 234 4 238

Average GS Grade

FY 2016 .............................................................................................. 13.1

FY 2017 .............................................................................................. 13.1

FY 2018 .............................................................................................. 13.1

FY 2019 .............................................................................................. 13.1

FY 2020............................................................................................... 13.1

1/ Excludes mandatory PCORTF FTEs. Includes reimbursable FTEs.

2/ For this and all other tables, the FY 2018 and FY 2019 columns contain information for the Agency for Healthcare Research and Quality and are

provided for convenience and transparency. The FY 2020 President’s Budget consolidates AHRQ’s activities into NIH, and the FY 2020 column




Detail of Full Time Equivalents (FTE) 1/ 2/

NIRSQ-43

FY 2018


FY 2020

President's

Budget

Executive level I ............................................... 3 3 3

Executive level II............................................... 6 5 5

Executive level III .............................................

Executive level IV..............................................

Executive level V...............................................

Subtotal Executive Level Positions............ 9 8 8

Total - Exec. Level Salaries 2,048,949$ 1,919,881$ 1,919,881$

Total SES, AHRQ 4 4

Total - ES Salary, AHRQ 788,097$ 782,518$

Total SES, NIRSQ 4

Total - ES Salary, NIRSQ 782,518$

GS-15................................................................... 63 63 40

GS-14................................................................... 69 71 59

GS-13................................................................... 68 69 47

GS-12................................................................... 16 16 11

GS-11................................................................... 8 8 8

GS-10...................................................................

GS-9..................................................................... 9 9 9

GS-8.....................................................................

GS-7..................................................................... 4 5 2

GS-6..................................................................... 2 2 2

GS-5..................................................................... 2 2 1

GS-4..................................................................... 1 1

GS-3.....................................................................

GS-2.....................................................................

GS-1.....................................................................

Subtotal ......................................................... 242 246 179

Average GS grade, AHRQ............................... 13.1 13.1

Average GS salary, AHRQ.............................. 96,970$ 97,431$

Average GS grade, NIRSQ.............................. 13.1

Average GS salary, NIRSQ.............................. 97,431$



Detail of Positions 1/ 2/

1/ Excludes Special Experts, Serivces Fellows and Commissioned Officer positions. Also excludes

positions financed using mandatory financing from the PCORTF.

2/ For this and all other tables, the FY 2018 and FY 2019 columns contain information for the Agency

for Healthcare Research and Quality and are provided for convenience and transparency. The FY

2020 President’s Budget consolidates AHRQ’s activities into NIH, and the FY 2020 column


NIRSQ-44


FY 2020 Congressional Justification

Programs Proposed for Elimination

Health Information Technology Research Portfolio

Authorizing Legislation: Title III and IX and Section 947(c) of the Public Health Service Act.

Budget Authority (BA)1:

FY 2018

Final

FY 2019

Enacted

FY 2020

President's

Budget

FY 2020 +/-

FY 2019

BA $16,500,000

$16,500,000

$0

-$16,500,000

1For this and all other tables, the FY 2018 and FY 2019 columns contain information for the Agency for Healthcare Research and Quality and are

provided for convenience and transparency. The FY 2020 President’s Budget consolidates AHRQ’s activities into NIH, and the FY 2020 column


Program funds are allocated as follows: Competitive Grants/Cooperative Agreements;

Contracts; and Other.

Program Description and Accomplishments

The purpose of the Health Information Technology (Health IT) portfolio is to rigorously show

how health IT can improve the quality of American health care. The portfolio develops and

synthesizes the best evidence on how health IT can improve the quality of American health care,

disseminates that evidence, and develops evidence-based tools for the effective use of health IT.

By identifying what works and developing resources and tools, the portfolio has played a key

role in the Nation’s drive to accelerate the use of safe, effective, patient-centered health IT

innovations.

In FY 2018, the Health IT portfolio within AHRQ will fund $14.0 million in research grants to

increase understanding of the ways health IT can improve health care quality. Early research

efforts built the evidence base regarding facilitators and barriers to health IT adoption and the

value of health IT implementation. Research in 2018 expanded on solutions for health IT access

to healthcare consumers through patient-facing technologies like patient portals. AHRQ supports

research to determine how these patient-facing technologies can best improve the quality and

effectiveness of care and several of these studies are scheduled for completion in 2018. Results

from these studies are providing evidence-based, practical methods to improve the adoption and

accessibility of these technologies.

NIRSQ-45

AHRQ’s health IT research also supported key HHS priorities such as alleviating EHR-related provider

burden through usability research that focuses on how to design and implement electronic health records

(EHRs) so that they are more intuitive to use and more readily support clinical workflow. In addition,

$2.5 million in contract funds were used to support the synthesis and dissemination of health IT

evidence. At the FY 2019 Enacted level, the Health IT portfolio continues total funding of $16.5

million.

Funding History within AHRQ

Fiscal Year Amount

FY 2016 $21,500,000

FY 2017 $16,500,000

FY 2018 Final $16,500,000

FY 2019 Enacted $16,500,000

FY 2020 President’s Budget $0

Budget Request

The FY 2020 President’s Budget does not consolidate this activity of AHRQ’s in NIH. The FY

2020 Budget Request is $0.0 million, a decrease of $16.5 million from AHRQ’s FY 2019

Enacted. The goal of the reorganization is to focus resources on the highest priority research,

reorganize federal activities in a more effective manner, and provide increased coordination on

health services research activities and patient safety. The FY 2020 President’s Budget ends

dedicated funding for health IT. Instead, health IT research will compete for funding

opportunities within patient safety and health services research to ensure the highest priority

research is funded.

NIRSQ-46

Program Section Total FTEs CEs Total FTEs CEs Total FTEs CEs Total FTEs CEs Total FTEs CEs Total FTEs CEs

Prevention and Public

Health Fund 4002

AHRQ Mandatory -$ 0 0 384$ 3 0 -$ 0 0 -$ 0 0 -$ 0 0 -$ 0 0

NIRSQ Mandatory

Patient-Centered

Outcomes Research Trust

Fund 6301

AHRQ Mandatory -$ 0 0 -$ 0 0 366$ 4 0 633$ 6 0 1,505$ 13 0 1,644$ 10 0

NIRSQ Mandatory




FTEs Funded by the Affordable Care Act 1/

FY 2013FY 2012FY 2011FY 2010 FY 2014 FY 2015

FY 2020

Program Section Total FTEs CEs Total FTEs CEs Total FTEs CEs Total FTEs CEs Total FTEs CEs

Prevention and Public

Health Fund 4002

AHRQ Mandatory -$ 0 0 -$ 0 0 -$ 0 0 -$ 0 0

NIRSQ Mandatory -$ 0 0

Patient-Centered

Outcomes Research Trust

Fund 6301

AHRQ Mandatory 1,430$ 10 0 1,387$ 8 0 1,129$ 8 0 1,500$ 7 0

NIRSQ Mandatory 1,500$ 7 0

1/ For this and all other tables, the FY 2018 and FY 2019 columns contain information for the Agency for Healthcare Research and Quality and are provided for convenience and transparency. The FY 2020

President’s Budget consolidates AHRQ’s activities into NIH, and the FY 2020 column represents the request for the National Institute for Research on Safety and Quality.

FY 2019FY 2018 FY 2016 FY 2017

NIRSQ-47



Key Outputs and Outcomes Tables

Program: Patient Safety

Measure Year and Most Recent

Result /

Target for Recent Result /

(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020

Target

+/-FY 2019

Target

1.3.38 Increase the

number of users of

research using AHRQ-

supported research tools

to improve patient safety

culture (Outcome)

FY 2018: 3531 users of

research

(Target Exceeded)

3650 users of

research

3750 users of

research

+100 users of

research

1.3.41 Increase the

cumulative number of

evidence-based resources

and tools available to

improve the quality of

health care and reduce the

risk of patient harm.

(Outcome)

FY 2018: 191 tools and

evidence-based resources

(Target Exceeded)

200 tools and

evidence-based

resources

215 tools and

evidence-based

resources

+15 tools

1.3.62 Reduce the rate of

CAUTI cases in hospital

intensive care units

(ICUs) (Outcome)

FY 2017:

1.60 CAUTI/1,000 catheter

days:

Baseline NHSN Rate

10.26 CAUTI/10,000 patient

days:

Baseline Population Rate

Target:

Baseline NHSN Rate and

Population Rate established

(Target Met)

5% reduction

from FY 2019

Baseline NHSN

and Population

Rates.

5% reduction

from FY 2020

Baseline NHSN

and Population

Rates

N/A

NIRSQ-48

1.3.38: Increase the number of users of research implementing AHRQ-supported patient

safety culture surveys

As an indicator of the number of users of research, the Agency relies in part on Surveys on

Patient Safety Culture (SOPS). AHRQ developed SOPS to support a culture of patient safety and

quality improvement in the Nation's health care system. The safety culture surveys and related

resources can be used by hospitals, nursing homes, medical offices, and community pharmacies.

Each SOPS survey has an accompanying toolkit that contains: survey forms, survey items and

dimensions, survey user's guide, and a data entry and analysis tool.

Healthcare organizations can use SOPS to: raise staff awareness about patient safety, examine

trends in culture over time, conduct internal and external benchmarking, and identify strengths

and areas for improvement. SOPS can be used to assess the safety culture of individual units and

departments or organizations as a whole.

Since the 2004 release of the hospital SOPS, thousands of health care organizations have

implemented the surveys and downloaded SOPS and the related resources from the AHRQ Web

site. The interest in the resources has remained strong over the past 13 years as evidenced by

electronic downloads, orders placed for various products, participation in SOPS Webinars, and

requests for technical assistance.

In response to requests from SOPS users and patient safety researchers, AHRQ established

comparative databases as central repositories for survey data from healthcare organizations that

have administered the SOPS. Upon meeting minimal eligibility requirements, healthcare

organizations can voluntarily submit their survey data for aggregation and compare their safety

culture survey results to others. In FY 2014, AHRQ moved to a bi-annual collection of survey

data to enhance accuracy of the survey results and reduce the burden on organizations.

In FY 2018, the submissions to the comparative databases were provided by 3,531 users of

research, including: 630 hospitals; 2,437 medical offices; 209 nursing homes; and 255

community pharmacies. This number does not reflect users of the Ambulatory Surgery Center

SOPS since there is not currently a comparative database for this particular SOPS survey. In FY

2019 and 2020, the Agency projects that the users of the comparative databases will remain in a

steady state due to a levelling off of comparative database activities. The number of SOPS users,

who submit results to the comparative databases, is only a portion of the total number of users.

1.3.41: Increase the cumulative number of evidence-based resources and tools available to

improve the quality of health care and reduce the risk of patient harm.

A major output of the Patient Safety Portfolio is the availability of evidence-based resources and

tools that can be utilized by healthcare organizations to improve the care they deliver, and,

specifically, patient safety. An expanding set of evidence-based tools is available as a result of

ongoing investments to generate knowledge through research and synthesize and disseminate

this new knowledge in the optimal format to facilitate its application.

NIRSQ-49

The Agency has provided resources and tools such as:

AHRQ Patient Safety Network (AHRQ PSNet) & Web M&M (Morbidity and Mortality

Rounds on the Web);

AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention;

Common Formats (standardized specifications for reporting patient safety events);

The Community-Acquired Pneumonia (CAP) Patient Safety Clinical Decision Support

Implementation Toolkit;

Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and

Families;

Improving Medication Safety in High Risk Medicare Beneficiaries Toolkit;

Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication

Reconciliation;

Nursing Home Antimicrobial Stewardship Modules;

Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality

Improvement

Re-Engineered Discharge (RED) Toolkit;

The Six Building Blocks: A Team-Based Approach to Improving Opioid Management in

Primary Care;

The Toolkit to Engage High-Risk Patients In Safe Transitions Across Ambulatory

Settings;

The Toolkit to Improve Safety for Mechanically Ventilated Patients; and

The Toolkit to Promote Safe Surgery.

The Patient Safety Portfolio is projecting that the number of evidence-based resources and tools

will continue to increase with a projected cumulative number of 200 in FY 2019 and 215 in FY

2020.

1.3.62: Reduce the rate of CAUTI cases in hospital intensive care units (ICUs)

A performance measure has been developed in connection with an HAI project as follow-on to

earlier CUSP projects. Data from the CUSP for CAUTI project have shown that hospital units

other than intensive care units (ICUs) have achieved greater reductions in CAUTI rates than

ICUs. It appears that this difference is related to the clinical culture of the ICU, where staff who

are treating critically ill patients favor maintaining indwelling urinary catheters to closely

monitor urine output for relatively longer times than in non-ICUs. In a similar vein, some

hospitals in the CUSP for CLABSI project did not achieve the significant reductions in CLABSI

rates that were attained by their peers. The current HAI project is adapting CUSP to bring down

persistently elevated CAUTI and CLABSI rates in ICUs. The performance measure focuses on

CAUTI rates because the baseline rate for CAUTI is likely to be easier to estimate and more

stable than for CLABSI.

In FY 2020, AHRQ will continue the expansion of the CUSP project for reducing CAUTI and

CLABSI rates in ICUs with persistently elevated rates of these infections, using FY 2019 funds.

This expansion from four regions of the country to nationwide coverage was initially funded

NIRSQ-50

with FY 2017 funds, and expansion activities began at the beginning of FY 2018. The FY 2020

HAI performance measure assesses progress toward reducing the rate of CAUTI in ICUs

participating in the CUSP project.

In FY 2017, data were available from a sufficient number of ICUs participating in the project to

allow the derivation of two overall baseline rates of CAUTI from the baseline rates of all the

then-participating ICUs. The first baseline rate is the National Healthcare Safety Network

(NHSN) rate. This rate is defined as the number of CAUTI cases per 1,000 catheter days. An

important approach for reducing CAUTI cases is to reduce the use of catheters and thus the

number of catheter days. However, to the extent that this effort succeeds, it lowers the

denominator in the NHSN rate and thereby appears to raise the CAUTI rate. A second rate is

therefore being used: the population rate, defined as the number of CAUTI cases per 10,000

patient days. The denominator of this rate is not affected by a reduction in the number of catheter

days.

In FY 2017, as shown in the table, the NHSN rate was 1.60 CAUTI/1,000 catheter days (1,190

CAUTI cases/742,297 catheter days). The population rate was 10.26 CAUTI/10,000 patient days

(1,189 CAUTI cases/1,158,974 patient days).

The FY 2017 baseline rate provides an initial picture of the CAUTI rates in the ICUs. However,

this rate will not be used to gauge progress in FY 2018, FY 2019, or FY 2020 because ICUs will

be recruited into the project on a rolling basis. Instead, a contemporaneous baseline CAUTI rate

will be derived from all the ICUs participating in the project in FY 2018, FY 2019, and FY 2020,

respectively. Given the virtual absence of reductions in CAUTI rates observed in ICUs in the

nationwide CUSP for CAUTI project, the targets for FY 2018, FY 2019, and FY 2020 will have

to be set quite conservatively in light of the fact that the participating ICUs have been chosen

because they are among the lower-performing units in terms of reducing their rate of CAUTI

(and/or CLABSI).

Recruitment of the project’s FY 2018 cohort, consisting of 126 ICUs, has been completed. The

baseline period for the cohort runs from May 2017 to April 2018. In light of data lags, complete

baseline data for the entire cohort are expected to be available in October 2018. The intervention

period for the cohort runs from May 2018 to April 2019. Results are expected to be available in

late summer 2019.

NIRSQ-51

Program: Health Services Research, Data and Dissemination (HSR)


Result /


(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020

Target

+/-FY 2019

Target

2.3.8 Increase the

availability of electronic

clinical decision support

tools related to safe pain

management and opioid

prescribing (Output)

FY 2018: Developed and

tested a dashboard that

aggregates pain-related

information into one

consolidated view for

clinicians. Information

includes data such as pain

medications, pain

assessments, pain-related

diagnoses, and relevant lab

test results.

(Target Met)

Test, revise, and

disseminate at

least one new

electronic

clinical decision

tool related to

safe pain

management and

opioid

prescribing

Partner with

stakeholders to

identify

additional

evidence-based

electronic

clinical decision

tools related to

safe pain

management and

opioid

prescribing and

make them

publicly

available

Develop, test,

and disseminate

at least one

electronic

clinical decision

support tool

related to

opioids or safe

chronic pain

management

N/A

Addressing the nation’s opioid epidemic is an ongoing focus of AHRQ’s Health Services

Research, Data, and Dissemination portfolio. In FY 2017, AHRQ contributed to all five pillars

of the Department of Health and Human Services comprehensive opioids strategy. Our work

included practical health services research, data explorations, and public dissemination. Our

dissemination activates included producing systematic evidence reviews on non-opioid pain

management and the use of naloxone by emergency medical service personnel and publishing a

collection of over 250 field-tested tools to support the delivery of Medication Assisted Treatment

(MAT) in primary care settings. Using AHRQ data platforms, AHRQ produced a series of

analysis documenting trends in health care utilization fueled by the opioid epidemic at state and

national levels and which uncovered the diverse ways in which the crisis is manifesting itself

across the country. In FY 2017, AHRQ also continued to support both investigator-initiated

health services research on the prevention and treatment of opioid addiction by health care

delivery organizations and targeted health services research expanding access to MAT in rural

communities through primary care.

NIRSQ-52

In FY 2017, AHRQ initiated a new initiative to ensure that health care professionals have access

to evidence supporting safe pain management and opioid prescribing at the point of care through

electronic clinical decision support (CDS). This effort is part of AHRQ’s overall CDS initiative,

funded by resources from the Patient-Centered Outcomes Research Trust Fund, to advance

evidence into practice through CDS and to make CDS more shareable, standards-based, and

publicly-available. The infrastructure for developing and sharing these CDS tools is called CDS

Connect (https://cds.ahrq.gov).

In FY 2018, AHRQ developed a dashboard that aggregates pain-related information from the

EHR into one consolidated view for clinicians. The information includes data such as pain

medications, pain assessments, relevant diagnoses, and lab test results. The dashboard was tested

in partnership with OCHIN, a network of community health centers, and uses the HL7 FHIR

standard, which allows for interoperability and implementation in different EHRs.

In FY 2018 and continuing in FY 2019, AHRQ will disseminate safe pain management and

opioid-related CDS through CDS Connect. This includes the pain management dashboard

developed in FY 2018. AHRQ continues to present its work in CDS at national meetings of key

organizations, such as the American Medical Informatics Association and the Healthcare

Information and Management Systems Society. In addition, AHRQ will continue to work with

its federal partners to disseminate safe pain management and opioid CDS tools. For example, the

CDC uses AHRQ’s CDS Connect web platform as a dissemination mechanism for two opioid

CDS tools that were developed by CDC and ONC.

In FY 2019 and continuing in FY2020, AHRQ will develop, test, and disseminate another

electronic clinical decision support tool related to opioids or safe chronic pain management.

AHRQ will continue to work with its partners and stakeholders on dissemination.

NIRSQ-53

Program: United States Preventive Services Task Force (USPSTF)


Result /


(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020

Target

+/-FY 2019

Target

2.3.7 Increase the

percentage of older adults

who receive appropriate

clinical preventive

services (Output)

FY 2018: PSAQ data

collection began and is

underway.

(In Progress)

Continue PSAQ

data collection

through 2019.

The panel design

of the survey

features several

rounds of

interviewing

covering two

full calendar

years. Data

should be

available in

2020.

New data for the

PSAQ

prevention items

available

Begin analysis

on the new data

N/A

2.3.7: Increase the percentage of adults who receive appropriate clinical preventive services

In FY 2018, the Agency for Healthcare Research and Quality (AHRQ) continued to provide

ongoing scientific, administrative and dissemination support to the U.S. Preventive Services

Task Force (USPSTF). The Task Force makes evidence-based recommendations about clinical

preventive services to improve the health of all Americans (e.g., by improving quality of life and

prolonging life). By supporting the work of the USPSTF, AHRQ helps to identify appropriate

clinical preventive services for adults, disseminate clinical preventive services recommendations,

and develop methods for understanding prevention in adults.

For several years, AHRQ has invested in creating a national measure of the receipt of appropriate

clinical preventive services by adults (measure 2.3.7). A necessary first step in creating quality

improvement within health care is measurement and reporting. Without the ability to know

where we are and the direction we are heading, it is difficult to improve quality. This measure

will allow AHRQ to assess where improvements are needed most in the uptake of clinical

preventive services. It will help AHRQ support the USPSTF by targeting its recommendations

and dissemination efforts to the populations and preventive services of greatest need. Thus,

making sure the right people get the right clinical preventive services, in the right interval. The

data from this measure can also identify gaps in the receipt of preventive services and therefore

inform the Department’s and the public health sector’s prevention strategies.

NIRSQ-54

AHRQ now has a validated final survey to collect data on the receipt of appropriate clinical

preventive services among adults (the Preventive Services Self-Administered Questionnaire

(PSAQ) in the Agency for Healthcare Research and Quality (AHRQ) Medical Expenditure Panel

Survey (MEPS)). The survey was fielded in a pilot test in 2015. It is a self-administered

questionnaire that will be included as part of the standard MEPS starting in 2018. In FY 2017,

AHRQ developed a baseline for national estimates of receipt of high-priority clinical preventive

services among adults for this performance measure. Survey results found that eight percent of

adults (35+) received all of the high priority, appropriate clinical preventive services (95%

Confidence Interval: 6.5% to 9.5%).

In FY 2019 and FY 2020, AHRQ will administer the PSAQ again. The panel design of the

survey, which features several rounds of interviewing covering two full calendar years, makes it

possible to determine how changes in respondents' health status, income, employment, eligibility

for public and private insurance coverage, use of services, and payment for care are related. Once

data is collected, it is reviewed for accuracy and prepared to release to the public. NIRSQ

expects data to be available in 2020 and analysis can begin thereafter. Additional years of data

will allow for AHRQ to track and compare receipt of high priority, appropriate clinical

preventive services over time.

NIRSQ-55

Program: Medical Expenditure Panel Survey (MEPS)


Result /


(Summary of Result)

FY 2019

Target

FY 2020

Target

FY 2020

Target

+/-FY 2019

Target

1.3.16 Maintain the

number of months to

produce the Insurance

Component tables

following data collection

(MEPS-IC) (Output)

FY 2018: 6 months

(Target Met)

6 months 6 months Maintain

1.3.19 Increase the

number of tables per year

added to the MEPS table

series (Output)

FY 2018: 9,377 total tables

in MEPS table series

(Target Exceeded)

9627 total tables

in MEPS table

series

9877 total tables

in MEPS table

series

+250 total tables in

MEPS table series

1.3.21 Decrease the

number of months

required to produce

MEPS data files (i.e.

point-in-time, utilization

and expenditure files) for

public dissemination

following data collection

(MEPS-HC) (Output)

FY 2018: 9 months

(Target Met)

9 months 9 months Maintain

The Medical Expenditure Panel Survey (MEPS) data have become the linchpin for economic

models of health care use and expenditures. The data are key to estimating the impact of

changes in financing, coverage and reimbursement policy on the U.S. healthcare system. No

other surveys provide the foundation for estimating the impact of changes in national policy on

various segments of the US population. These data continue to be key for the evaluation of

health reform policies and analyzing the effect of tax code changes on health expenditures and

tax revenue.

1.3.16: Maintain the number of months to produce the Insurance Component tables

following data collection (MEPS-IC)

The MEPS-IC measures the extent, cost, and coverage of employer-sponsored health insurance

on an annual basis. These statistics are produced at the National, State, and sub-State

(metropolitan area) level for private industry. Statistics are also produced for State and Local

governments. Special request data runs, for estimates not available in the published tables, are

made for Federal and State agencies as requested.

NIRSQ-56

The MEPS-IC provides annual National and State estimates of aggregate spending on employer-

sponsored health insurance for the National Health Expenditure Accounts (NHEA) that are

maintained by CMS and for the Gross Domestic Product (GDP) produced by Bureau of

Economic Analysis (BEA). MEPS-IC State-level premium estimates are the basis for

determining the average premium limits for the federal tax credit available to small businesses

that provide health insurance to their employees. MEPS-IC estimates are used extensively for

analyses by federal agencies including:

Congressional Budget Office (CBO);

Congressional Research Service (CRS);

Department of Treasury;

The U.S. Congress Joint Committee on Taxation (JCT);

The Council of Economic Advisors, White House;

Department of Health and Human Services (HHS), including

Assistant Secretary for Planning and Evaluation (ASPE)

Centers for Medicare & Medicaid Services (CMS)

Schedules for data release will be maintained for FY 2018 through FY 2019. Further reducing

the target time is not feasible because the proration and post-stratification processes are

dependent upon the timing and availability of key IRS data that are appended to the survey

frame. Data trends from 1996 through 2016 are mapped using the MEPSnet/IC interactive

search tool. In addition, special runs are often made for federal and state agencies that track data

trends of interest across years.

1.3.19: Increase the number of tables included in the MEPS Tables Compendia.

The MEPS HC Tables Compendia has recently been updated moving to a more user friendly and

versatile format (https://meps.ahrq.gov/mepstrends/home/index.html). Interactive tables are

provided for the following: use, expenditures and population; health insurance, accessibility and

quality of care; medical conditions and prescribed drugs.

The MEPS Tables Compendia is scheduled to be expanded a minimum of 250 tables per year.

For the Insurance Component there are a total of 2,603 national level tables and 5,443 state and

metro area tables. The total number of tables available to the user population is currently 8,046.

The MEPS Tables Compendia is a source of important data that is easily accessed by users.

Expanding the content and coverage of these tables furthers the utility of the data for conducting

research and informing policy. Currently data are available in tabular format for the years 1996

– 2016. This represents twenty years of data for both the Household and Insurance Components,

enabling the user to follow trends on a variety of topics.

https://meps.ahrq.gov/mepstrends/home/index.html

NIRSQ-57

1.3.21: MEPS-HC: Decrease the number of months required to produce MEPS data files

(i.e. point-in-time, utilization and expenditure files) for public dissemination following data

collection.

In coordination with the MEPS Household Component contractor the Center for Financing,

Access and Cost Trends (CFACT) senior leadership have met on a continuing basis to establish a

strategy to address the delivery schedule. The following steps have and will continue to be taken

in an effort to release public use files as early as possible: 1) data editing now takes place in

waves (batch processing) rather than data processing taking place all at once at the completion of

date collection; 2) processing of multiple data sets now takes place concurrently rather than

consecutively, thus multiple processes take place at any given point in time; 3) duplicative

processes have either been eliminated or combined with similar processes; 4) review time of

intermediate steps was reduced; 5) the contractor has eliminated a number of edits or streamlined

such processes where they were determined to provide minimal benefit in relation to the

resources utilized; and 6) contractor editing staff have been cross-trained in order to more

efficiently distribute work assignments.

We have achieved the data release schedule for all the targeted MEPS public release files that

were scheduled for release during FY 2018. We are on target to also meet the data release

schedule for the MEPS public use files scheduled for release during FY 2019. The release date

for public use files (jobs, home health, other medical expense, dental visits, medical provider

visits, outpatient department visits, emergency room visits, hospital stays, prescribed drugs, and

full year consolidated) will be maintained moving from FY 2018 to FY 2019. The current

release dates for all public use files will be maintained for FY 2020.

The data delivery schedule increases the timeliness of the data and thus maximizes the public

good through the use of the most current medical care utilization and expenditure data possible.

Such data are used for policy and legislative analyses at the Federal, state and local levels as well

as the private health care industry and the health services research community in an effort to

improve the health and well-being of the American people.

NIRSQ-58

Summary of Proposed Changes in Performance Measures

AHRQ/NIRSQ 1/

Unique

Identifier

Change

Type

Original in FY

2019 CJ Proposed Change Reason for Change

HHS

Performance

Plan

(APP/R)

Measure

1.3.19 Modify

Target

9449 total tables in

MEPS table series

9627 total tables in

MEPS table series

Increase in target

based on FY 2018

Results

No

1.3.60 Delete Measure was

defunded in 2020

President's Budget

Delete measure:

Identify key design

principles that can

be used by health

IT designers to

improve Personal

Health Information

Management

(PHIM)

Program defunded No

1/ The FY 2018 and FY 2019 columns contain information for the Agency for Healthcare Research and Quality and

is provided for convenience and transparency. The FY 2020 President’s Budget consolidates AHRQ’s activities into

NIH, and the FY 2020 column represents the requests for the National Institute for Research on Safety and Quality.

NIRSQ-59

Physicians’ Comparability Allowance (PCA)

1) Department and component:

Agency for Healthcare Research and Quality/National Institute for Research on Safety and

Quality 1/

2) Explain the recruitment and retention problem(s) justifying the need for the PCA pay authority.

Most, if not all, of the research positions at AHRQ are in occupations that are in great demand,

commanding competitive salaries in an extremely competitive hiring environment. This

includes the 602 (Physician) series which is critical to advancing AHRQ’s mission to produce

evidence to make health care safer, higher quality, more accessible, equitable, and affordable.

Since the Agency has not utilized other mechanisms for the 602 series (for example, Title 38), it

is imperative that the Agency offers PCAs to recruit and retain physicians at AHRQ. In the

absence of PCA, the Agency would be unable to compete with other Federal entities within HHS

and other sectors of the Federal government which offer supplemental compensation (in addition

to base pay) to individuals in the 602 series.

3-4) Please complete the table below with details of the PCA agreement for the following years:

AHRQ

2018 Final

AHRQ

FY 2019

Enacted

NIRSQ

FY 2020

President’s

Budget

3a) Number of Physicians Receiving PCAs 22 22 21

3b) Number of Physicians with One-Year PCA Agreements 0 0 0

3c) Number of Physicians with Multi-Year PCA Agreements 22 22 21

4a) Average Annual PCA Physician Pay (without PCA payment) 154,213 149,699 143,406

4b) Average Annual PCA Payment $24,409 24,429 24,285

1/ For this and all other tables, the FY 2018 and FY 2019 column contains information for the Agency for Healthcare Research and Quality and are provided for convenience and transparency. The FY 2020 President’s Budget consolidates AHRQ’s activities into NIH, and the FY 2020

column represents the request for the National Institute for Research on Safety and Quality.

5) Explain the degree to which recruitment and retention problems were alleviated in your agency through

the use of PCAs in the prior fiscal year.

(Please include any staffing data to support your explanation, such as number and duration of unfilled positions and number of

accessions and separations per fiscal year.)

PCA contracts are used as a tool to alleviate recruitment problems and attract top private sector

physicians into public sector positions. These recruitments give the Agency a well-rounded and

highly knowledgeable staff.

6) Provide any additional information that may be useful in planning PCA staffing levels and amounts in

your agency.

NIRSQ-60

SIGNIFICANT ITEMS FOR AHRQ IN THE HOUSE, SENATE, AND CONFERENCE

REPORTS1

Antibiotic Resistance

1. SENATE (Rept. 115-289)

The Committee notes that while AHRQ has been the leader in developing the tools and resources

to help providers improve their antibiotic stewardship programs, the agency has not updated

several publications related to the use of procalcitonin [PCT] tests in sepsis and antibiotic

treatment programs in more than 5 years. The Committee encourages AHRQ to collaborate with

NIH, HRSA, BARDA, CDC, FDA and other relevant agencies to review and update their

publications with the latest FDA approved uses for PCT tests in antibiotic stewardship. The

Committee requests an update on these activities in the fiscal year 2020 CJ.

Action Taken or to be Taken:

On November 15, 2018, AHRQ staff met with leadership from Thermo Fisher Scientific, one of

the companies that manufactures the procalcitonin test. AHRQ staff discussed the Agency’s role

in evidence development through AHRQ’s Evidence-based Practice (EPC) program, and

emphasized the need to forge partnerships with professional and/ or medical societies for the

EPC systematic reviews so that the partner organizations could use the latest evidence for the

development of best practice tools such as clinical practice guidelines or professional society

recommendations. AHRQ recommends such an approach be pursued before updating

publications related to PCT tests in sepsis and antibiotic treatment programs. AHRQ staff will

reach out to NIH, HRSA, BARDA, CDC, FDA, and other relevant agencies to see if there is

interest in supporting a systematic evidence review on PCT tests in sepsis and antibiotic

treatment programs

Centers of Diagnostic Excellence


Centers of Diagnostic Excellence.--The Committee is concerned about the lack of dedicated

funding for research into improving how medical conditions are diagnosed, considering the

size and impacts of patient harms resulting from diagnostic safety and quality challenges. The

Committee encourages AHRQ to dedicate resources to support the creation of Centers of

Diagnostic Excellence that will create core diagnostic research hubs for diagnostic safety and

quality research; utilize strategic partnerships that capitalize on the capabilities of both academic

research institutions and non-academic healthcare, science, and technology stakeholders; and

incentivize high-impact research on novel solutions to improve diagnosis.

1 Since the Budget does not fund AHRQ, the responses for AHRQ are included here, as NIRSQ is absorbing the activities of AHRQ.

NIRSQ-61


AHRQ shares the Committee’s concern about improving how medical conditions are diagnosed

in an effort improve patient safety and quality of care. AHRQ is working to develop a

solicitation for grant applications (RFA, Request for Applications) to address diagnostic safety

and quality. The additional $2 million AHRQ received in the FY2019 appropriation will be

obligated for this grant funding opportunity, which will begin to address the impacts of patient

harms resulting from diagnostic safety and quality challenges.

Diabetes


The Committee is concerned about the significant costs associated with providing care for

individuals that suffer from diabetes, including those from medically underserved low health

literacy populations. The Committee encourages AHRQ consider a pilot or demonstration

program to support safety net clinics in increasing health literacy and preventing diabetes with

the goal of reducing long-term costs.


In FY 2019, AHRQ anticipates funding investigator-initiated grants that use innovative

approaches to data analytics to assess community patterns of chronic illness and modifiable risk

factors, and clinical and community resources to support chronic disease prevention and

management. Successful applicants will propose using data to support patient navigators

embedded in primary care practices to identify patients at high risk for preventable disease or

disease progression and connect them to clinical and community services in order to improve

health outcomes. Given the prevalence of prediabetes and diabetes, we anticipate that some of

these projects will focus on diabetes prevention and management.

Malnutrition


The Committee greatly appreciates AHRQ's work to better understand malnutrition in U.S.

hospitals. The Committee particularly notes AHRQ's initiative to support studies, the

``Characteristics of Hospital Stays Involving Malnutrition, 2013'' and follow-up ``All-Cause

Readmissions Following Hospital Stays for Patients with Malnutrition, 2013'' that illustrated the

consequences of malnutrition in hospital patients. The Committee urges AHRQ to convene a

technical expert panel to assess the evidence for a malnutrition-related readmissions quality

measure for the prevention of malnutrition in hospitals.

NIRSQ-62

Action Taken or to be Taken

AHRQ has updated the 2013 studies on malnutrition. To further our understanding of

malnutrition in U.S. hospitals, AHRQ released a report entitled “Non-Maternal and Non-

Neonatal Inpatient Stays in the United States Involving Malnutrition, 2016 (August, 2018).

As a follow-up to the 2013 national estimates, this report presents national estimates on the

characteristics of inpatient stays and 30-day readmissions for malnutrition in 2016

(https://hcup-us.ahrq.gov/reports/HCUPMalnutritionHospReport_083018.pdf).

AHRQ is exploring the feasibility of convening a technical expert panel to assess the evidence

for quality measures related to malnutrition in FY 2020. While the panel would focus on the

evidence for all malnutrition-related measures, particular emphasis would be placed on evidence

for measures focused on the elderly population.

Nursing


The Committee notes that AHRQ-led research often highlights the unique contribution of nurses,

including advanced practice and doctorally-prepared nurses. The Committee urges AHRQ to

continue supporting health services research that takes into consideration the contributions of all

providers, including nurses.


AHRQ recognizes the important contributions of all members of clinical teams to improve the

quality of care, and the importance of multidisciplinary teams in conducting health services

research. AHRQ welcomes all opportunities to support nurses including advanced practice and

doctorally-prepared nurses as well as other clinicians in conducting health services research.

Palliative Care


The Committee encourages AHRQ to consult with appropriate professional societies, hospice

and palliative care stakeholders, and relevant patient advocate organizations to develop and

disseminate information to patients, families, and health professionals about palliative care as an

essential part of the continuum of quality care for patients with serious or life-threatening illness.

Such materials and resources should include specific information regarding the demonstrated

benefits of patient access to palliative care and the interdisciplinary services provided to patients

by professionals trained in hospice and palliative care. The Secretary is encouraged to include

NIRSQ-63

such information and materials on websites of relevant Federal agencies and departments,

including the Centers for Medicare & Medicaid Services and the Administration for Community

Living.


AHRQ recognizes that hospice and palliative care are a critical part of the continuum of high

quality care for patients facing serious or life-threatening illness. AHRQ would be very

interested in engaging with a variety of stakeholders on this topic to develop and disseminate

information about palliative and hospice care given adequate resources to support this work.

AHRQ will explore the feasibility of conducting an evidence synthesis of approaches taken by

health systems and health plans to deliver palliative care; evidence about tools and resources for

delivery of palliative care and its implementation, or factors associated with the effectiveness of

palliative care.

Research and Training

7. SENATE (Rept.115-289)

The Committee notes the important role that AHRQ plays in supporting research training and

career development activities, such as ``K'' Awards and Mentored Clinical-Scientist

Development Awards. Considering the current challenges facing physician-scientists

and the young-investigator pipeline, AHRQ is encouraged to continue to prioritize these

activities.


AHRQ is committed to fostering the next generation of health services researchers and uses

investigator-initiated funding announcements to support and enhance the education and career

development of young research investigators. AHRQ’s research training opportunities are

designed to prepare researchers to address the vast changes occurring in health care delivery. In

FY2018, AHRQ awarded over $3 million ($3,065,323) in new training grants including

dissertation grants and mentored career development awards. In addition, AHRQ awarded over

$7 million ($7,410,716) in new institutional training grants and post-doctoral fellowships under

the National Research Service Award program. AHRQ receives many inquiries about the

research training programs available and will continue to provide these research training

opportunities in the upcoming year.

NIRSQ-64

Open Access to Federal Research


The Committee has received reports from the Office of Science and Technology Policy [OSTP]

on the progress of all Federal agencies in developing and implementing policies to increase

public access to federally funded scientific research. The Committee commends the agencies

funded in this bill who have issued plans in response to OSTP’s policy directive issued in 2013.

The Committee urges the continued efforts towards full implementation of the plan, and directs

agencies to provide an update on progress made in the fiscal year 2020 CJ. This will ensure that

the Committee remains apprised of the remaining progress needed to make federally funded

research accessible to the public as expeditiously as possible.


AHRQ implemented its Policy for Public Access to AHRQ-Funded Scientific Publications on

February 19, 2016 (https://grants.nih.gov/grants/guide/notice-files/NOT-HS-16-008.html). The

Policy requires that AHRQ-funded authors submit an electronic version of the author’s final

peer-reviewed accepted manuscript to the National Library of Medicine (NLM)'s PubMed

Central (PMC) upon acceptance by a journal, and to be made publicly available within 12

months of the publisher’s date of publication. PMC is the designated repository of publications

from AHRQ-funded grants, contracts, cooperative agreements, and intramural research.

In support of AHRQ users and manuscripts, AHRQ’s staff closely monitor the AHRQ PMC

submissions and produce monthly internal access reports, in close communications with NLM.

Since the AHRQ Policy was in effect in 2016, a total of 4,342 AHRQ funded publications have

been submitted to PMC. The submission of and public access to AHRQ funded publications

continue to grow. For instance, from 2013-2015 AHRQ was receiving 50-100 submissions per

year. Since 2016 the yearly submission reaches over 1,000. Average number of times AHRQ-

supported publications accessed per month is 189,282 as of November 2018, as compared to

24,184 as of January 2017.

AHRQ has drafted Policy on Data Management Plan for both extramural and intramural

research. This policy is to specify AHRQ’s expectations for researchers to describe in the grant

application and/or research proposal how the project team will manage and disseminate the

primary data, samples, physical collections and other supporting materials created or gathered in

the course of work. It is the first step to facilitate the prompt and broad dissemination of data, to

make available to the public all scientific data arising from unclassified research and programs

funded wholly or in part by AHRQ. The draft policy is currently under review.

https://grants.nih.gov/grants/guide/notice-files/NOT-HS-16-008.html

NIRSQ-65

SIGNIFICANT ITEMS

FY 2019 HOUSE REPORT 115-862

Sepsis Testing

1. HOUSE (Rept. 115-862)

AHRQ has been the leader in developing the tools and resources to help providers improve their

antibiotic stewardship programs. The Committee is concerned that AHRQ has not updated

several publications related to the use of procalcitonin (PCT) tests in sepsis and antibiotic

treatment programs in more than five years. High sensitive PCT tests are critical tools for

initiating and discontinuing antibiotic therapies and play a key role in antibiotic stewardship

programs. The Committee urges AHRQ to collaborate with NIH, HRSA, BARDA, CDC, FDA,

and other relevant agencies to review and update their publications with the latest FDA approved

uses for PCT tests in antibiotic stewardship. The Committee requests an update on these

activities in the fiscal year 2020 Congressional Justification.


On November 15, 2018, AHRQ staff met with leadership from Thermo Fisher Scientific, one of

the companies that manufactures the procalcitonin test. AHRQ staff discussed the Agency’s role

in evidence development through AHRQ’s Evidence-based Practice (EPC) program, and

emphasized the need to forge partnerships with professional and/ or medical societies for the

EPC systematic reviews so that the partner organizations could use the latest evidence for the

development of best practice tools such as clinical practice guidelines or professional society

recommendations. AHRQ recommends such an approach be pursued before updating

publications related to PCT tests in sepsis and antibiotic treatment programs. AHRQ staff will

reach out to NIH, HRSA, BARDA, CDC, FDA, and other relevant agencies to see if there is

interest in supporting a systematic evidence review on PCT tests in sepsis and antibiotic

treatment programs

NIRSQ-66

SIGNIFICANT ITEMS

FY 2019 CONFERENCE Report (115-952)

Diagnostic Quality and Safety

1. CONFERENCE (Rept. 115-952)

Within the patient safety portfolio, the conferees include $2,000,000 to support grants to address

diagnostic errors, which may include the establishment of Research Centers of Diagnostic

Excellence to develop systems and new technology solutions to improve diagnostic safety and

quality.


AHRQ appreciates the Committee’s support for recognizing the importance of improving

diagnostic safety and quality in health care. As a result, AHRQ is working to develop a

solicitation for grant applications (RFA, Request for Applications) to address diagnostic safety

and quality. The additional $2 million appropriation will be obligated for this grant funding

opportunity.

Population Health Research

2. CONFERENCE (Rept. 115-952)

The conferees provide $2,000,000 for the Director, in consultation with the Centers for Medicare

& Medicaid Services, to establish a program to explore the effectiveness of data computing

analytics to identify trends in chronic disease management and support the development of

protocols for intervention and utilization of health care navigators to carry out those intervention

strategies. The Director shall work in cooperation with qualified public institutions of higher

education


AHRQ appreciates the Committee’s support to address chronic disease management. On

November 26, 2018, AHRQ published a notice of intent to fund investigator-initiated grants in

FY 2019 that would use data analytics to assess community patterns of chronic illness,

modifiable risk factors, and clinical and community resources to support chronic disease

prevention and management. Successful applicants will use data to support patient navigators

embedded in primary care practices to identify patients at high risk for preventable disease or

disease progression and connect them to clinical and community services in order to improve

health outcomes. AHRQ anticipates publishing a Request for Applications or “RFA” early in

2019.

Documents

FY 2020 Budget Page No. · mission. A reduction of $4.2 million in FY 2020 will reduce the number of recommendations the USPSTF will make from an average of 12 recommendations per